National Paediatric Diabetes Audit Report 2012-13

Report 1: Care Processes and Outcomes

October 2014

Report produced by the National Paediatric Diabetes Audit, Royal College of Paediatrics and Child Health Contents

List of tables and figures........................................................................................................3 Foreword..................................................................................................................................6

1. Summary of key findings .....................................................................................................8
2. Introduction .......................................................................................................................10
3. Coverage and participation .............................................................................................12
4. Demographic and population assessment .......................................................................13 4.1 Registrations ..................................................................................................................13 4.1.1 Registrations by age and sex .....................................................................................13 4.1.2 Registrations by ethnicity and region .........................................................................14 4.1.3 Registrations by diabetes type ..................................................................................16 4.1.4 Registrations by diabetes type and ethnicity .............................................................18 4.2 Incidence rates .............................................................................................................19 4.2.1 Incidence rates by country for Type 1 diabetes .........................................................19
5. Care processes and treatment targets .............................................................................22 5.1 Care processes .............................................................................................................22 5.2 HbA1c analysis .............................................................................................................25
6. Outcomes of care .............................................................................................................28 6.1 Treatment targets .......................................................................................................28 6.1.2 HbA1c target achievement .......................................................................................29 6.1.3 Paediatric Diabetes Unit Variation in HbA1c ............................................................33 6.2 Funnel plots of mean HbA1c by Paediatric Diabetes Unit ...........................................39
7. Conclusions and recommendations .................................................................................46
8. Acknowledgements and collaborators ...........................................................................47
9. References .........................................................................................................................49 10 Appendix A: Data on Paediatric Diabetes Units in the 2012-13 National Paediatric Diabetes Audit .................................................................50 11 Appendix B: Unadjusted and adjusted Paediatric Diabetes Unit co-ordinates for funnel plots .................................................................69

# List of tables and figures

| Table number | Title | Page number | |--------------|----------------------------------------------------------------------|-------------| | 1 | Diabetes registrations by country, age and English region in 2012-13 | 13 | | 2 | Number of children and young people with diabetes by gender and age band, for England and Wales combined in 2012-13 | 14 | | 3 | Percentage of children and young people with diabetes by ethnic group in 2012-13 | 15 | | 4 | Percentage of children and young people with diabetes by sex and type, for England and Wales in 2012-13 | 17 | | 5 | Percentage of children and young people with diabetes by type and ethnic group, England and Wales in 2012-13 | 18 | | 6a | Type 1 diabetes incidence rates per 100,000 persons by age group and sex in 2012-13 | 19 | | 6b | Numbers of newly diagnosed children and young people with Type 1 diabetes by country, gender and age group in 2012-13 | 19 | | 7 | Percentage of children and young people cared for in a PDU having key age-specific care processes recorded (for HbA1c this is all ages) from 2004-05 to 2012-13 | 23 | | 8 | Percentage of children and young people with HbA1c measured, by age and sex in 2012-13 | 25 | | 9 | Number and percentage of children and young people with diabetes achieving the HbA1c target of \<58 mmol/mol, ≥58 mmol/mol to ≤80 mmol/mol, and >80 mmol/mol, by country and sex in 2012-13 | 29 | | 10 | Percentage by HbA1c target band achieved, England and Wales in 2010-11, 2011-12 and 2012-13 | 30 | | 11 | HbA1c (mmol/mol) target band achieved (number and %) by ethnic group for England and Wales in 2012-13 | 30 | | 12 | Mean and standard deviation, median and interquartile ranges for HbA1c in mmol/mol by country and English region in 2012-13. | 33 | | 13 | Multiple regression showing the predictive risk factors for patient HbA1c in England and Wales in 2012-13 | 41 | | 14 | Logistic regression model of risk factors for proportion of children and young people with diabetes in England and Wales with an HbA1c greater than 80 mmol/mol in 2012-13 | 44 |

| Figure number | Title | Page number | |---------------|----------------------------------------------------------------------|-------------| | 1 | PDUs that submitted data to the NPDA in 2012-13 | 12 | | 2 | Number of children and young people with diabetes by gender and age band, for England and Wales combined in 2012-13 | 14 | | 3 | Percentage of children and young people with diabetes by ethnic group in 2012-13 | 16 | | | Description | Page | |---|-----------------------------------------------------------------------------|------| | 4a | Age-Sex Type 1 diabetes incidence rates by country | 20 | | 4b | Time trends in Age-Specific Type 1 diabetes incidence rates for England and Wales combined | 20 | | 5a | Type 1 diabetes incidence rate by country and English region in 2012-13 | 22 | | 5b | Time trends in the incidence of Type 1 diabetes by country and region from 2010-11 to 2012-13 | 21 | | 6 | Percentage of children and young people with diabetes aged 12 years and over, having all care processes recorded from 2004-05 to 2012-13 | 23 | | 7 | Percentage of care process incomplete (except HbA1c) by Paediatric Diabetes Unit in 2012-13 | 24 | | 8a | Percentage of males who had their HbA1c measured in England and Wales | 26 | | 8b | Percentage of females who had their HbA1c measured in England and Wales | 26 | | 9 | Percentage who did NOT have the HbA1c care process completed, England and Wales by Paediatric Diabetes Unit in 2012-13 | 27 | | 10 | Percentage of children and young people achieving the NICE recommended HbA1c target of \<58 mmol/mol, ≥58 mmol/mol to ≤80 mmol/mol, and >80 mmol/mol, by country in 2012-13 | 29 | | 11 | Percentage of children and young people with diabetes by HbA1c target band achieved and ethnic group in 2012-13 | 31 | | 12 | Percentage achievement of HbA1c target of \<58 mmol/mol by Paediatric Diabetes Unit in 2012-13 | 32 | | 13 | Box and whisker plots of HbA1c by Paediatric Diabetes Unit, Wales in 2012-13 | 34 | | 14 | Box and whisker plots of HbA1c by Paediatric Diabetes Unit, East of England in 2012-13 | 34 | | 15 | Box and whisker plots of HbA1c by Paediatric Diabetes Unit, Yorkshire and the Humber in 2012-13 | 35 | | 16 | Box and whisker plots of HbA1c by Paediatric Diabetes Unit, East Midlands in 2012-13 | 36 | | 17 | Box and whisker plots of HbA1c by Paediatric Diabetes Unit, West Midlands in 2012-13 | 36 | | 18 | Box and whisker plots of HbA1c by Paediatric Diabetes Unit, South Central in 2012-13 | 36 | | 19 | Box and whisker plots of HbA1c by Paediatric Diabetes Unit, North West in 2012-13 | 37 | | 20 | Box and whisker plots of HbA1c by Paediatric Diabetes Unit, North East in 2012-13 | 37 | | | Description | Page | |---|-----------------------------------------------------------------------------|------| | 21 | Box and whisker plots of HbA1c by Paediatric Diabetes Unit, South West in 2012-13 | 38 | | 22 | Box and whisker plots of HbA1c by Paediatric Diabetes Unit, London in 2012-13 | 38 | | 23 | Box and whisker plots of HbA1c by Paediatric Diabetes Unit, South East in 2012-13 | 39 | | 24 | Funnel plot showing the unadjusted mean HbA1c for PDUs in England and Wales by unit size in 2012-13 | 40 | | 25 | Funnel plot showing the adjusted mean HbA1c for PDUs in England and Wales by unit size in 2012-13 | 42 | | 26 | Funnel plot showing the unadjusted proportion of children and young people with diabetes in England and Wales with HbA1c greater than 80 mmol/mol against unit size | 43 | | 27 | Funnel plot showing the adjusted proportion (%) of children and young people with diabetes in England and Wales with HbA1c greater than 80 mmol/mol against unit size in 2012-13 | 45 | Foreword

We are delighted to introduce the third annual National Paediatric Diabetes Audit (NPDA) report prepared by the Royal College of Paediatrics and Child Health (RCPCH) which covers the audit period 2012-13 for the Paediatric Diabetes Units (PDUs) in England and Wales. The NPDA has been running in its entirety for 10 years and has become a powerful measuring tool for providing benchmarked information relating to outcomes and quality of care for children and young people with diabetes.

The NPDA has undergone several changes over the last three years including the collection of some new data items and use of median HbA1c for the Audit year, rather than simply relying on the HbA1c value for each individual patient. This has put extra burden on centres submitting data but is clearly important, as it brings the NPDA into line with other international registries and audits, making benchmarking against other countries more meaningful. The NPDA project team are aware of the challenges that exist when submitting to the Audit, together with the considerable amount of time taken to collect and prepare data that is of good quality and as complete as possible.

The NPDA recognises the significant additional investment in Paediatric Diabetes, particularly in England where the ‘Best Practice Tariff’ together with the quality assurance peer review programme should lead to improved quality of care and outcomes. The first round of peer review visits to PDUs will be complete for both England and Wales by the end of 2014. We recognise the considerable burden that has been placed on each PDU, not only in submitting their data to the NPDA, but also preparing for their peer review quality assurance visit alongside striving to deliver their diabetes services at ‘Best Practice Tariff’ standard.

Results from the NPDA over the last 10 years have been disappointing, with little evidence of any change in outcomes. Therefore, questions have to be asked as to whether recent investment both of finance and time has made a difference.

This year’s NPDA report demonstrates some positive changes for England and Wales with a downward trend in the median HbA1c by 2 mmol/mol from the previous year which now represents the third consecutive year where there has been improvement in the national median HbA1c. This may not feel like a large improvement, but is coherent with rates of change seen in other European countries where measures have already been taken to improve outcomes.

There is still work to be done as, despite this overall improvement in the median HbA1c, the percentage of children and young people with diabetes who have a median HbA1c less than 58 mmol/mol remains low and the number with an HbA1c greater than 80 mmol/mol remains stubbornly high. Furthermore, children and young people with diabetes from ethnic minority groups perform less well than those from white ethnic backgrounds. However, it is not clear why these differences exist.

Of concern is the large variability in outcome measures that persist across regional diabetes networks and PDUs. Even after statistical adjustments for known confounding influences, such as ethnicity, social deprivation, gender, age and diabetes duration, over 90% of the variation in HbA1c is unaccounted for. This suggests that much of the variation is due to differences in service provision and delivery which needs addressing. Network working and ‘peer review’ are paving the way towards the sharing of good practice and the NPDA fully endorse this approach. It is recommended that PDUs use the ‘casemix’ adjustments presented in this report to identify their outlier status, and benchmark themselves against others with a similar patient demographic, location or size and work within networks to employ strategies to improve outcomes and reduce variability.

Finally, we would like to thank the NHS clinical teams who have provided the data to support this important Audit and applaud the clinical leadership that has led to these improvements. With this strong support of the NPDA together with the work being carried out across the regional diabetes networks, we have confidence in steady ongoing improvements of care across England and Wales. Children and young people with diabetes deserve nothing less.

Dr Justin Warner\
RCPCH NPDA Clinical Lead\
Consultant in Paediatric Endocrinology and Diabetes\
University Hospital of Wales

Dr Fiona Campbell\
Chair of NPDA dataset working group\
Consultant Paediatric Diabetologist\
Leeds Teaching Hospitals NHS Trust

1. Summary of key findings

Coverage of children and young people with diabetes by the National Paediatric Diabetes Unit (NPDA) has remained stable. Records from 25,314 children and young people with diabetes were submitted to the 2012-13 NPDA, compared with 25,390 in 2011-12. The reported year of 2012-13 is the second year of the new dataset and data collection process. A total of 25,221 children and young people under the age of 25 years with a diagnosis of diabetes who were cared for in Paediatric Diabetes Units (PDUs) in 2012-13 were suitable for analysis by the NPDA reporting from 178 PDUs. This represents 100% of all PDUs where children and young people in England and Wales receive their diabetes care.

Key improvements offered by this report are in recording of individual care processes from previous years. The percentage of children and young people diagnosed with diabetes for at least one year and over the age of 12 years at the start of the Audit year with all care processes recorded, as recommended by the National Institute for Health and Care Excellence (NICE), has almost doubled from 6.7% in 2011-12 to 12.1% in 2012-13. This higher proportion is very encouraging, but continues to fall short of similar data from the 2011-12 National Diabetes Audit (NDA) report for adults with diabetes. The proportion of adults receiving all eight adult care processes was 42.4% for Type 1 diabetes for England and Wales.

The number of patient visits, or records of HbA1c and other tests submitted per patient, has continued to increase. During 2012-13, there were 106,333 reported visits from 25,221 patients, an average of four visits per patient. There has been a marked increase in HbA1c measurement. In England, 98.6% of males and females under the age of 25 years had their HbA1c measured, compared with 89% in 2011-12. In Wales, the corresponding figures are 98.9% and 87%. This shows a continued improvement on 2010-11 when the completion rate for this care process was 85%.

There has been a small decrease in the percentage of children and young people with diabetes who achieve an HbA1c less than 58 mmol/mol (from 17.4% in 2011-12 to 15.8% in 2012-13). However, this still represents either an improvement or similarity to 2009-10 and 2010-11 where the figures were 14.5% and 15.8% respectively. The greatest numbers (58.4%) of patients have an HbA1c between 58 mmol/mol and 80 mmol/mol. Just over one quarter of children and young people have an unacceptable HbA1c of greater than 80 mmol/mol. A much higher proportion of children and young people with diabetes from ethnic minorities (26.4% to 36.4% depending on the ethnic group) have an HbA1c level greater than the 80 mmol/mol.

In 2012-13 the median HbA1c for England and Wales was 69 mmol/mol, down from 71 mmol/mol in 2011-12. This represents the third consecutive year where there has been a sustained fall in the national median HbA1c. However, there is variability between nations and regional networks ranging from a median of 68-72 mmol/mol.

Casemix adjustment has demonstrated that only 8% of the variability in the mean HbA1c, and 7% of the variability of the proportion with an HbA1c >80 mmol/mol, across PDUs can be explained by factors such as ethnicity, social deprivation, gender, age and diabetes duration. Therefore, over 90% must be explained by service related factors such as structure, resource and delivery of care. The NPDA calls for a concerted effort to reduce this variability which is already being addressed through networking and the peer review accountability programme. The funnel plots presented in this report identify outliers for two measures, mean HbA1c and percentage of patients with HbA1c greater than 80 mmol/mol. The NPDA urge PDUs to take notice of this data and implement strategies to improve the status of all PDUs where performance is suboptimal.

Alongside this report, there will be a separate complications report covering the 2012-13 hospital admissions data relating to diabetic ketoacidosis hypoglycaemia and ‘without complications’. 2. Introduction

The National Paediatric Diabetes Audit (NPDA) report highlights the main findings on the quality of care for children and young people with diabetes mellitus in England and Wales. This is the 10th report and covers data submitted for patients under the age of 25 years and cared for in Paediatric Diabetes Units (PDUs) in 2012-13. This is the third report from the Royal College of Paediatric and Child Health (RCPCH). The NPDA is commissioned and sponsored by the Healthcare Quality Improvement Partnership (HQIP) as part of their National Clinical Audit Programme. The programme is funded by NHS England and the Welsh Government.

The NPDA covers the components of the National Service Framework (NSF) for diabetes and includes details on the number of children and young people with diabetes in England and Wales, together with the care processes they receive and outcome measures, including inpatient admissions for diabetic ketoacidosis. This report covers the care process and outcome data only, with complications data to follow in a separate report.

The National Diabetes Audit (NDA) for adults reports on the provision of core diabetes care for everyone with diabetes. This provides commissioners with age, ethnicity and social deprivation-related perspectives across the whole population for which they are responsible. The NDA also reports to participating individual General Practices and adult specialist services, allowing them to benchmark their care against their peers. The NPDA reports separately to individual participating PDUs regarding their provision of diabetes care for the children and young people attending their services. Those reviewing the NDA and NPDA reports side-by-side need to be aware of these differences but, equally, those wanting to get the most complete picture of local needs and service provision should consider the two reports together\*\*

Following the launch of a new dataset in 2011-12, 2012-13 has been a year of consolidation for the NPDA. Over the 10 years that the NPDA has been the basis for data collection on process and outcome measures of care for children and young people with diabetes, there have been many changes in the way services are structured and delivered. Participation in the NPDA is now a mandatory standard for PDUs and hospital trusts to receive tariff in England. Currently, no such commissioning arrangements exist for Wales. Peer review, as part of a quality assurance programme, has completed its first self-assessment exercise in England with ongoing review visits taking place in 2014. Wales is following this programme of peer review, which should also be complete by the end of 2014. The NPDA acts as the measuring arm of any quality assurance programme and it is therefore encouraging to see the early signs of improvement in outcome, with a third consecutive yearly fall in the median HbA1c. However, there are variations across regional networks, which will require close and careful monitoring over the next few years.

For the first time this year, each PDU has been provided with their unadjusted and adjusted mean HbA1c and percentage of children and young people that would be expected to have an HbA1c greater than 80 mmol/mol based on the population characteristics of their geographical area. This will allow units to compare their crude outcomes with those adjusted for their ‘casemix’ which allows a more equitable comparison of Units. Furthermore, the use of funnel plots provides a technique for identifying outliers and is now the recognised statistical methodology for this purpose used by other national audits across England and Wales. Data quality is of paramount importance when submitting data and PDUs are reminded to check the data quality report provided by the RCPCH and act on any outstanding issues. The NPDA can only analyse data that fulfil the data entry criteria. Data submitted for patients must include a valid NHS number, date of birth, date of diagnosis and gender to be eligible for any analysis. Furthermore, they must be assigned a PDU PZ code. Care processes and outcomes can only be analysed if the result is a valid response and the date of measurement falls within the Audit year. When submitting data, one row of data represents one visit and multiple entries within one cell of a csv format spreadsheet are unacceptable. In the past, much data submitted had to be excluded, as it does not fulfil these criteria. The NPDA would urge submitting PDUs to check their data quality and accuracy to avoid any data being excluded.

The NPDA hope that PDUs will use the data presented in this annual report to continue to benchmark their own centres against others and explore methods of driving up quality of care for their patients. The RCPCH and the NPDA would like to thank every PDU that submitted data to the 2012-13 Audit. The team recognises that this can be a time-consuming process, particularly where there is a lack of resource and/or computer software to aid data collection.

\*\* Because the care of adults and children with diabetes is mixed between GP services (this includes ALL patients) and hospital, paediatric and community specialist services (these each include SOME patients), the different ‘views’ that the two national audits NDA and NPDA give to the providers of the services will inevitably include overlapping patients. Thus someone with diabetes attending a specialist service should also appear in the relevant GP report. The NDA integrates data from participating specialist and GP services for adults with diabetes so that if a care process or treatment target is recorded by one but not the other both get the complete data reported back to them i.e. a ‘whole person’ view. This makes sense because it reflects the fact that there is no clinical value in duplicating something carried out elsewhere. The population level NDA reports include all people with diabetes in a geographical area irrespective of their mix of provider services and use integrated data where they are available.

The NPDA runs independently of the NDA and of GP services so its data are not integrated making it possible that GP reports do not include all care processes or treatment targets measured in specialist paediatric units and vice versa. Specialist paediatric diabetes units are primarily responsible for the care of most children and young people with diabetes and for the collection of their care process and outcome data. Although GPs do not provide the majority of care for children and young people living with diabetes they do prescribe all their medications. Therefore it is in this age group, and also adults with Type 1 or complex diabetes that attend specialist services not participating in NDA, where lack of data integration is most likely to result in a slightly deficient ‘whole systems’ view. Furthermore, for under-17s, the age cut-off for the QOF GP incentive scheme means that there is no financial value to the practice in replicating results from external services. Nonetheless, because less than 10% of all people with Type 1 diabetes, and less than 1% of people with diabetes in general are under 17 years old, the overall impact on population level NDA results is minimal. 3. Coverage and participation

A total of 178 PDUs in England and Wales successfully submitted data to the 2012-13 NPDA. A PDU is defined as a unit which delivers a paediatric diabetes healthcare service. It may represent one or more hospitals, as some services provide care across multiple sites. Data were received from 164 PDUs in England and from 14 PDUs within the six Health Boards in Wales, comprising all services registered with the NPDA for both nations.

Figure 1: PDUs that submitted data to the NPDA 2012-13 4. Demographic and population assessment

4.1 Registrations

Records from 25,314 children and young people with diabetes were submitted to the 2012-13 NPDA, a similar number to the 25,390 submitted in 2011-12. A total of 157 of these patients were registered in two or more regions. Since multiple patient visits can be entered for each patient, there were a total of 107,657 visits submitted to the 2012-13 NPDA. However, 1,324 of these visit records have been excluded from the 2012-13 analysis for a combination of reasons, including, for example, missing patient NHS number, missing date of birth, more than one valid date of birth for the same NHS number and age greater than 25 years. Therefore, for England and Wales combined, there was a total of 106,333 visits recorded for 25,221 children and young people under the age of 25 years old registered with diabetes and with a valid age and sex attached to their record, reported from 178 PDUs. This equates to approximately four patient visits per annum.

Table 1 shows the breakdown in registration by country, age and English region. The age breakdown categories are the same as in the Census and other Office for National Statistics publications. Within England, the maximum number of registrations across all age groups was observed in the North West and the South East of England regions. It has not been possible to disaggregate the South East region into its two networks because of Census 2011 changes to both regions and local authorities (LAs) within them. In both England and Wales, age groups 10-14 and 15-19 years comprised the two largest groups of registered children and young people with diabetes.

Table 1: Diabetes registrations by country, age and English region in 2012-13

| Age Group | 0-4 | 5-9 | 10-14 | 15-19 | 20-24 | Total | |-----------|-----|-----|-------|-------|-------|-------| | England and Wales | 1,470 | 5,009 | 10,759 | 7,895 | 83 | 25,216 | | England | 1,384 | 4,732 | 10,129 | 7,474 | 82 | 23,801 | | Wales | 87 | 278 | 634 | 426 | \<5 | 1,426 | | Regions in England | | | | | | | | East of England | 152 | 515 | 1,072 | 912 | 13 | 2,664 | | East Midlands | 105 | 388 | 774 | 525 | 0 | 1,792 | | London | 176 | 548 | 1,000 | 722 | \<5 | 2,449 | | North East | 67 | 212 | 522 | 369 | \<5 | 1,172 | | North West | 210 | 645 | 1,420 | 883 | 44 | 3,202 | | South Central | 121 | 453 | 940 | 743 | 9 | 2,266 | | South East | 178 | 597 | 1,281 | 871 | 5 | 2,932 | | South West | 113 | 390 | 909 | 717 | 7 | 2,136 | | West Midlands | 148 | 520 | 1,138 | 914 | 6 | 2,726 | | Yorkshire and the Humber | 139 | 508 | 1,123 | 833 | \<5 | 2,605 |

157 patients were registered in 2 or more regions. Patient counts reflect unique patients at each level of aggregation, and therefore may not balance across region and country totals.

4.1.1 Registrations by age and sex

Table 2 and Figure 2 show registrations for males and females in each age band. Patients in age groups 10-14 and 15-19 comprise the highest proportion of registrations in England and Wales. Slightly more young males have been registered with diabetes than females. Table 2: Number of children and young people with diabetes by gender and age band, for England and Wales combined in 2012-13

| | 0-4 | 5-9 | 10-14 | 15-19 | 20-24 | Total under 25 | |----------|------|------|-------|-------|-------|----------------| | Boys | 759 | 2,559| 5,435 | 4,136 | 45 | 12,934 | | Girls | 702 | 2,391| 5,207 | 3,708 | 38 | 12,046 | | Not Specified\* | 9 | 59 | 117 | 51 | 0 | 236 | | Total under 25 | 1,470| 5,009| 10,759| 7,895 | 83 | 25,216 |

- Includes responses ‘9 Not Specified’, blank and records where both male and female genders had been recorded for the same patient.

Figure 2: Number of children and young people with diabetes by gender and age band, for England and Wales combined in 2012-13

4.1.2 Registrations by ethnicity and region

Table 3 and Figure 3 show the percentage of children and young people registered with diabetes by ethnic group for 2012-13. Ethnicity coding is taken from the Information Standards Board (ISB) for Health and Social Care. A fundamental principle of ethnic category data collection is that the person to be categorised is responsible for classifying themselves, and that their reply is their own perception of their ethnic category, and not that of the healthcare professional. However, the Department of Health guidance acknowledges that there are some unavoidable exceptions (such as for those who for reasons of illness are unable to respond or be understood) where it may not be possible or appropriate to collect this data. The NPDA is not able to verify that this process has taken place. The majority of children and young people with diabetes are white but there is regional variability. In England, Asians and Mixed ethnic groups were the two next largest. Of 25,374 records, 4,269 had an ethnicity recorded as ‘not stated’. The national code of ‘not stated’ means that the person has been asked and has declined to respond either because they do not wish to provide this information, or due to a genuine inability to choose a response, it does not mean the ethnic category is unknown. The ethnicity of an additional 759 patients were invalid or left blank, so were classified as ‘unknown’ in accordance with NHS Data Dictionary ethnicity definitions.

For PDUs in Wales, 99.2% of records provide some form of ethnic origin; the corresponding figure from England is 96.9%, which is significantly improved from 2010-11 when 72.6% of registrations from England specified ethnic origin. However, 17.7% of records from England are ‘not stated’ whereas in Wales 2.1% are ‘not stated’. It seems likely that this difference could be due to some PDUs misclassifying ‘unknown’ ethnicity as ‘not stated’. This seems to be particularly prevalent in North East, North West and West Midlands regions. The NPDA has reminded PDUs of the correct process for classifying ethnicity for the 2013-14 data submission.

Table 3: Percentage of children and young people with diabetes by ethnic group in 2012-13

| | White | Asian | Black | Mixed | Other | Not stated | Unknown\* | |----------------------|-------|-------|-------|-------|-------|------------|----------| | England and Wales | 70.2 | 4.4 | 1.8 | 2.5 | 1.3 | 16.8 | 3.0 | | England | 68.7 | 4.6 | 1.9 | 2.6 | 1.4 | 17.7 | 3.1 | | Wales | 94.5 | 0.8 | 0.2 | 1.3 | 0.4 | 2.1 | 0.8 | | Regions in England | | | | | | | | | East of England | 73.9 | 2.6 | 0.4 | 2.1 | 0.8 | 15.1 | 5.1 | | East Midlands | 87.3 | 6.1 | 0.9 | 2.3 | 0.6 | 2.1 | 0.8 | | London | 42.6 | 9.8 | 10.7 | 8.5 | 5.2 | 19.2 | 3.9 | | North East | 65.4 | 0.4 | 0.1 | 0.3 | 0.1 | 33.4 | 0.3 | | North West | 69.1 | 3.7 | 0.7 | 1.0 | 1.1 | 23.5 | 0.8 | | South Central | 71.7 | 1.8 | 0.5 | 1.8 | 0.4 | 19.3 | 4.4 | | South East | 70.1 | 5.3 | 2.6 | 3.2 | 1.9 | 12.3 | 4.6 | | South West | 76.9 | 0.7 | 0.9 | 1.5 | 0.2 | 11.1 | 8.7 | | West Midlands | 59.3 | 5.9 | 0.5 | 2.5 | 1.6 | 28.7 | 1.5 | | Yorkshire and the Humber | 75.4 | 7.0 | 0.6 | 1.4 | 1.0 | 14.1 | 0.6 |

\*Unknown includes patients with blank or invalid ethnicity values in all their records 4.1.3 Registrations by diabetes type

Over 98% of the records submitted to the Audit had a diabetes type recorded. Table 4 shows the breakdown of diabetes type by sex, country and English region. The vast majority of children and young people with diabetes have Type 1 diabetes, although there is variability across regions in England. In both England and Wales there were slightly more male patients with Type 1 diabetes. The second major group was those with Type 2 diabetes. Table 4: Percentage of children and young people with diabetes by sex and type, for England and Wales, in 2012-13

| Region | Type 1 Diabetes Mellitus | Type 2 Diabetes Mellitus | Cystic Fibrosis Related Diabetes | Monogenic forms of Diabetes (gene known) | Monogenic forms of Diabetes (gene unknown) | Other specified forms of Diabetes Mellitus\* | Not Specified forms of Diabetes Mellitus\* | |-------------------------|--------------------------|--------------------------|----------------------------------|----------------------------------------|------------------------------------------|-------------------------------------------|------------------------------------------| | | Boys | Girls | Boys | Girls | Boys | Girls | Boys | Girls | Boys | Girls | Boys | Girls | Boys | Girls | Boys | Girls | | England and Wales | 97.0 | 94.3 | 1.0 | 2.7 | 0.3 | 0.7 | 0.3 | 0.3 | 0.1 | 0.0 | 0.4 | 0.7 | 0.9 | 1.3 | | England | 97.0 | 94.2 | 1.1 | 2.8 | 0.3 | 0.6 | 0.3 | 0.3 | 0.1 | 0.0 | 0.5 | 0.7 | 0.9 | 1.3 | | Wales | 98.1 | 96.0 | 0.5 | 1.8 | 0.3 | 1.2 | 0.3 | 0.4 | 0.0 | 0.1 | 0.1 | 0.1 | 0.7 | 0.3 | | Regions in England | | | | | | | | | | | | | | | | East of England | 94.2 | 91.7 | 0.4 | 1.1 | 0.3 | 0.4 | 0.3 | 0.2 | 0.0 | 0.0 | 0.5 | 0.2 | 4.2 | 6.4 | | East Midlands | 97.8 | 96.6 | 0.9 | 2.2 | 0.1 | 0.4 | 0.3 | 0.0 | 0.0 | 0.1 | 0.3 | 0.2 | 0.6 | 0.5 | | London | 96.3 | 91.4 | 2.0 | 5.4 | 0.6 | 1.1 | 0.1 | 0.4 | 0.2 | 0.0 | 0.5 | 1.0 | 0.3 | 0.6 | | North East | 98.5 | 96.5 | 0.6 | 2.9 | 0.2 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.6 | 0.6 | | North West | 96.7 | 93.7 | 0.8 | 2.0 | 0.2 | 0.9 | 0.7 | 0.5 | 0.1 | 0.0 | 0.8 | 1.4 | 0.9 | 1.5 | | South Central | 98.4 | 95.5 | 0.7 | 2.3 | 0.5 | 0.6 | 0.2 | 0.7 | 0.0 | 0.1 | 0.1 | 0.6 | 0.1 | 0.3 | | South East | 97.7 | 95.6 | 1.3 | 2.5 | 0.0 | 0.4 | 0.2 | 0.1 | 0.0 | 0.0 | 0.1 | 0.7 | 0.6 | 0.6 | | South West | 98.4 | 95.4 | 0.5 | 1.9 | 0.6 | 1.8 | 0.3 | 0.8 | 0.1 | 0.0 | 0.2 | 0.1 | 0.0 | 0.0 | | West Midlands | 97.6 | 94.5 | 1.7 | 4.2 | 0.0 | 0.0 | 0.0 | 0.1 | 0.1 | 0.0 | 0.1 | 0.2 | 0.5 | 1.1 | | Yorkshire and the Humber| 95.5 | 93.9 | 1.5 | 2.6 | 0.5 | 0.6 | 0.3 | 0.6 | 0.2 | 0.0 | 1.6 | 1.8 | 0.4 | 0.5 |

- Patients were recorded as ‘other specified forms of diabetes mellitus’ where there is a recognised cause of diabetes (e.g. post organ transplantation, steroid induced diabetes, post pancreatitis/pancreatectomy) or related to a syndrome (e.g. Prader Willi or Lawrence Moon Biedl Syndrome). Where the patient has diabetes but the cause is unknown they are classified as ‘not specified forms of Diabetes Mellitus’. Monogenic forms of diabetes include neonatal diabetes. Due to rounding to one decimal place, the total may not add to 100 per cent. 4.1.4 Registrations by diabetes type and ethnicity

Table 5 shows the breakdown of children and young people with diabetes by type and ethnicity for England and Wales combined. There are a much higher proportion of children and young people with Type 2 diabetes in Asian, Black, Mixed and Other ethnicities compared to the White ethnic group.

Table 5: Percentage of children and young people with diabetes by type and ethnic group, England and Wales in 2012-13

| Diabetes type | White | Asian | Black | Mixed | Other | Not stated | Unknown | |----------------------------------------------------|-------|-------|-------|-------|-------|------------|---------| | **England and Wales** | | | | | | | | | Type 1 Diabetes Mellitus | 96.7 | 84.8 | 92.7 | 92.0 | 92.6 | 95.8 | 92.3 | | Type 2 Diabetes Mellitus | 1.0 | 8.9 | 5.8 | 4.6 | 4.2 | 2.3 | 4.2 | | Cystic Fibrosis Related Diabetes | 0.5 | 0.3 | 0.0 | 0.6 | 0.0 | 0.2 | 0.4 | | Monogenic forms of Diabetes (gene known) | 0.3 | 0.6 | 0.2 | 0.2 | 0.0 | 0.3 | 0.6 | | Monogenic forms of diabetes (gene unknown) | 0.0 | 0.3 | 0.0 | 0.0 | 0.0 | 0.1 | 0.0 | | Other specified forms of Diabetes Mellitus | 0.5 | 2.9 | 0.4 | 1.3 | 0.0 | 0.3 | 0.6 | | Not Specified forms of Diabetes Mellitus | 1.0 | 2.2 | 0.9 | 1.3 | 3.3 | 1.0 | 2.0 | 4.2 Incidence rates

4.2.1 Incidence rates by country for Type 1 diabetes

This section includes age and sex-specific diabetes population incidence rates for Type 1 diabetes for 2012-13. The age-specific incidence rate is defined as the number of newly diagnosed cases of diabetes in a specific age group over a specific time period (i.e. 2012-13 year period) per total number of children and young people in that age group in the general population. Recent evidence suggests that the incidence of Type 1 diabetes in children is rising and may double by 2020, which has important health care implications.(^5) NPDA incidence time trends need to be interpreted with caution, as the increase may be due to better coverage or ascertainment of patients with diabetes, rather than to a true increase in incidence. However, as numbers of cases have stabilised ascertainment is likely to be close to 100%.

Table 6a and Figure 4a show Type 1 diabetes incidence rates by age and sex for England and Wales in 2012-13. The age group of 10-14 years had the highest rate of incidence of Type 1 diabetes. In England and Wales, males had a higher rate of incidence than females, except in the 5-9 year age group. As the number of newly diagnosed patients aged 20-24 years cared for in a PDU is small, the incidence rate is not shown. Table 6b shows the numbers of newly diagnosed children and young people with Type 1 diabetes for England and Wales. There were 2,642 newly diagnosed patients with Type 1 diabetes, under the age of 20 years, in England and Wales during 2012-13 cared for in a PDU, with slightly more boys than girls. Figure 3b shows the overall incidence time trends by age over the last 3 audit year cycles. There have been minor changes in incidence but no clear trend in any direction.

Table 6a: Type 1 diabetes incidence rates per 100,000 persons by age group and sex in 2012-13

| Age Group | England | Wales | England and Wales | |-----------|---------|-------|-------------------| | | Boys | Girls | Boys | Girls | Boys | Girls | | 0-4 | 14.5 | 13.8 | 19.5 | 19.4 | 14.7 | 14.1 | | 5-9 | 22.9 | 24.3 | 23.3 | 33.1 | 22.9 | 24.8 | | 10-14 | 37.7 | 31.5 | 30.7 | 31.2 | 37.3 | 31.5 | | 15-19 | 8.2 | 6.0 | 7.9 | 5.2 | 8.2 | 6.0 | | Total under 20 | 20.3 | 18.5 | 19.9 | 21.5 | 20.3 | 18.7 |

Table 6b: Numbers of newly diagnosed children and young people with Type 1 diabetes by country, gender and age group in 2012-13

| Age Group | England | Wales | England and Wales | |-----------|---------|-------|-------------------| | | Boys | Girls | Not Specified | Total | Boys | Girls | Not Specified | Total | Boys | Girls | Not Specified | Total | | 0-4 | 251 | 229 | \<5 | 481 | 18 | 17 | 0 | 35 | 269 | 246 | \<5 | 516 | | 5-9 | 361 | 366 | 5 | 732 | 20 | 27 | 0 | 47 | 381 | 393 | 5 | 779 | | 10-14 | 580 | 462 | \<5 | 1,046 | 27 | 26 | 0 | 53 | 607 | 488 | \<5 | 1,099 | | 15-19 | 138 | 96 | \<5 | 235 | 8 | 5 | 0 | 13 | 146 | 101 | \<5 | 248 | | Total under 20 | 1,330 | 1,153 | 11 | 2,494 | 73 | 75 | 0 | 148 | 1,403 | 1,228 | 11 | 2,642 | Figure 4: Type 1 diabetes incidence rates per 100,000 persons by age group and sex in 2012-13

4a) Age-Sex Type 1 diabetes incidence rates by country

4b) Time trends in Age-Specific Type 1 diabetes incidence rates for England and Wales combined

Figure 5a shows the incidence rate in 2012-13, by country and by English region. For each region, the age group 10-14 years has the highest incidence rate, followed by those in age group 5-9 years. There is considerable variability in the overall incidence rate for children and young people with newly diagnosed Type 1 diabetes which is lowest in London and highest in the South East. Figure 5b shows the time trends in the incidence of Type 1 diabetes from 2010-11 to 2012-13. Although there is variability, there is no clear trend in any one country or region. Figure 5: Type 1 diabetes incidence rate by country and English region in 2012-13

5a) Type 1 diabetes incidence rate by country and region by age in 2012-13

\*The NPDA has not been able to show rates for the South Central region since it has not been possible to disaggregate the South East region into its two networks due to this no longer existing as an NHS administrative region and population estimates have not been available from ONS since 2011.

5b) Time trends in the incidence of Type 1 diabetes by country and region from 2010-11 to 2012-13

\*The NPDA has not been able to show rates for the South Central region since it has not been possible to disaggregate the South East region into its two networks due to this no longer existing as an NHS administrative region and population estimates have not been available from ONS since 2011. 5. Care processes and treatment targets

Audit question: What proportion of children and young people with diabetes are getting the key age-specific processes of diabetes care, and what proportion achieve treatment targets?

The NPDA collects information on the key care processes, recommended by the National Institute for Health and Clinical Excellence (NICE) for children and young people with diabetes. The NPDA measures the percentage of children and young people with diabetes who are receiving the seven key processes of care which include:

- Glycated Haemoglobin A1c (HbA1c)
- Body Mass Index (BMI) (both height and weight being recorded)
- Blood pressure
- Urinary albumin
- Cholesterol
- Eye screening
- Foot examination

Key care processes are recorded to monitor diabetes management and detect long-term complications at the earliest treatable stage. Guidelines specify a starting age of 12 years for commencing all care processes with the exception of HbA1c, which should be recorded in children and young people of all ages. The NPDA incorporates data collection for the age-relevant care process and provides analysis on this information.

In the analysis, children and young people were included if they had received a complete year of care, i.e. for 2012-13 had been diagnosed prior to 01 April 2012 and for all care processes, except HbA1c, were 12 years of age or older on 01 April 2012. Furthermore, the data entered needed to be valid and have a date of measurement recorded that was within the Audit year.

5.1 Care processes

During 2012-13 there has been a marked improvement in the completion of all the individual key care processes (Table 7). The percentage of children and young people over the age of 12 years with all care processes recorded has almost doubled from 6.7% in 2011-12 to 12.1% in 2012-13 (Table 7 and Figure 6). It is recognised that achieving a 100% completion rate for any particular care process within an audit year is not always possible due to non-attendance at clinics by some patients. Also, there may still be significant under-reporting of the care process being performed, but not recorded for audit purposes. The NPDA cannot validate this without a case note analysis for which it does not have permission. Continued improvement is required even to meet the completion rate of key care processes for adults with diabetes. The proportion receiving all checks in the National Diabetes Audit (NDA) 2011-12 for adults is 42.4% for those with Type 1 diabetes. Table 7: Percentage of children and young people cared for in a PDU having key age-specific care processes recorded (for HbA1c this is all ages) from 2004-05 to 2012-13

| | 2004-05 | 2005-06 | 2006-07 | 2007-08 | 2008-09 | 2009-10 | 2010-11 | 2011-12 | 2012-13 | |----------------------|---------|---------|---------|---------|---------|---------|---------|---------|---------| | HbA1c | 73.2 | 77.6 | 84.7 | 89.1 | 89.6 | 90.1 | 92.8 | 89.3 | 97.6 | | BMI | 50.5 | 53.0 | 60.5 | 73.2 | 66 | 70.2 | 75.3 | 64.7 | 87.9 | | Blood Pressure | 44.1 | 40.6 | 53.3 | 60.1 | 57.1 | 58.8 | 62.7 | 67.7 | 77.3 | | Urinary Albumin | 18.7 | 23.3 | 30.3 | 34.1 | 32.2 | 36.5 | 40.3 | 40.7 | 49.5 | | Cholesterol | 18.2 | 17.5 | 22.6 | 32.1 | 30.5 | 29.9 | 34.9 | 44.4 | 52.7 | | Eye screening | 17.7 | 15.3 | 25.2 | 25.7 | 26.9 | 25.8 | 35.8 | 36.9 | 49.7 | | Foot examination | 17.4 | 15.4 | 21.3 | 23.5 | 23.1 | 24.5 | 31.9 | 34.4 | 39.5 | | % (over 12) with all care processes recorded | 2.0 | 2.6 | 3.6 | 5.0 | 5.2 | 4.1 | 5.8 | 6.7 | 12.1 |

Figure 6: Percentage of children and young people with diabetes aged 12 years and over, having all care processes recorded from 2004-05 to 2012-13

Figure 7 shows the percentage of care processes incomplete (apart from HbA1c) by PDU. These care processes include measurement of cholesterol, blood pressure, urinary albumin, body mass index (both height and weight), eye screening and foot examination. Individual Units can be identified in Appendix A by their PZ number. There was only one PDU that returned a result of 100% incompleteness, compared with four in 2011-12, with a wide variation for others. This is much improved on 2010-11 when there were 20 PDUs with 100% incompleteness of care processes. Figure 7: Percentage of care process incomplete (except HbA1c) by Paediatric Diabetes Unit, 2012-13\*

Paediatric Diabetes Unit PZ codes\*

\*A list of Paediatric Diabetes Unit PZ codes and corresponding Unit names can be found in Appendix A 5.2 HbA1c Analysis

This section focuses specifically on the HbA1c care process as it is recommended as the best indicator of long-term diabetes control. The following analysis examines the percentage of children and young people, of all ages, who had their HbA1c checked and recorded as part of a care process. The outcome data for HbA1c are presented in section 6. In the analysis, children and young people with diabetes were included if they had received a complete year of care, i.e. for 2012-13 had been diagnosed prior to 01 April, 2012, and had at least one recorded HbA1c value.

Table 8 and Figure 8 show the percentage of children and young people in different age groups by sex and nation that had their HbA1c measured. In England 97.6% of males and females under the age of 25 years had their HbA1c measured and 98.9% in Wales. This is considerably improved from 2011-12, where 89.3% of males and females in England and Wales had their HbA1c measured.

Table 8: Percentage of children and young people with HbA1c measured by age and sex in 2012-13

| Age Group | Boys England | Boys Wales | Girls England | Girls Wales | |-----------|--------------|------------|---------------|-------------| | 0-4 | 97.7 | 97.1 | 96.4 | 100.0 | | 5-9 | 97.8 | 99.2 | 97.6 | 99.1 | | 10-14 | 98.0 | 99.7 | 97.9 | 97.6 | | 15-19 | 97.3 | 100.0 | 96.8 | 99.3 | | 20-24 | 87.9 | 0.0 | 94.3 | 0.0 | | Total Under 25 | 97.7 | 99.5 | 97.4 | 98.2 | Figure 8: Percentage of children and young people with HbA1c measured, by age and sex in 2012-13

8a) Percentage of males who had their HbA1c measured in England and Wales

8b) Percentage of females who had their HbA1c measured in England and Wales

Figure 9 is a bar chart of the percentage of patients who did not have the HbA1c care process completed, by PDU. The chart is a big improvement on 2011-12 where eight PDUs submitted less than 50% of their HbA1c data. Figure 9: Percentage who did NOT have the HbA1c care process completed, England and Wales by Paediatric Diabetes Unit\* in 2012-13

Paediatric Diabetes Unit PZ codes\* \*A list of Paediatric Diabetes Unit PZ codes and corresponding Unit names can be found in Appendix A 6. Outcomes of care

6.1 Treatment targets

Treatment targets can be viewed as part of the process of care or as an ‘intermediate outcome’, i.e. an intermediary step between a care process of the patient and a ‘hard’ endpoint such as development of complications. For 2012-13 the NPDA has reported HbA1c values in accordance with the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), i.e. standardised concentrations of mmol/mol only. HbA1c values submitted to the NPDA using the Diabetes Control and Complications Trial (DCCT) aligned measures of percentage (%) were converted to mmol/mol using the formula:

[ \\text{IFCC (mmol/mol)} = (10.93 \\times \\text{DCCT (%)} - 23.50 ]

In addition, from 2011-12, multiple HbA1cs have been submitted on each patient to give a more representative measure of diabetes control over the year of care, and to bring the analysis into line with other international reporting audits and registries, making benchmarking more representative.

There were a total of 76,011 HbA1c values submitted to the NPDA which could be included in this year’s analysis, after excluding 1,570 observations which contained no diagnosis date for the patient. HbA1c values recorded less than three months from diagnosis were then excluded as they are not representative of patients overall diabetes control, leaving 73,068 values. After data cleaning (removal of invalid values, date of measurement outside the Audit year, invalid PDU code, invalid gender), a total of 67,806 HbA1c values were retained. In keeping with other international audits and registries the median HbA1c value, rather than the mean for the year for each patient, was used in the analysis. Furthermore, there was little difference between means and medians at patient level. There was a total of 21,348 patients with at least one HbA1c recorded during the Audit year, giving an average of 3.1 HbA1c values per patient (range 1 to 19).

6.1.1 HbA1c target achievement

Table 9 shows the percentage of children and young people with diabetes achieving the HbA1c target ranges of less than 58 mmol/mol, equal to or greater than 58 mmol/mol to equal to or less than 80 mmol/mol, and greater than 80 mmol/mol by country and sex in 2012-13. There has been a small decrease in the overall percentage of children and young people with diabetes achieving an HbA1c less than 58 mmol/mol from 17.4% in 2011-12 to 15.8% in 2012-13. However, this still represents either an improvement or similarity to 2009-10 and 2010-11 where the figures were 14.5% and 15.8%, respectively. The greatest numbers (58.4%) of patients have an HbA1c between 58 mmol/mol and 80 mmol/mol. Just over one quarter of children and young people have an unacceptable HbA1c greater than 80 mmol/mol. Table 9: Number and percentage of children and young people with diabetes achieving the HbA1c target of \<58 mmol/mol, ≥58 mmol/mol to ≤80 mmol/mol, and >80 mmol/mol, by country and sex in 2012-13

| HbA1c \<58 mmol/mol | HbA1c ≥58 to ≤80 mmol/mol | HbA1c >80 mmol/mol | |-------------------|--------------------------|-------------------| | | Female | Male | Not specified | Total | Female | Male | Not specified | Total | Female | Male | Not specified | Total | | England | 1,479 | 1,724 | 7 | 3,210 | 5,606 | 6,125 | 16 | 11,747 | 2,613 | 2,575 | 6 | 5,194 | | % | 15.3 | 16.5 | 24.1 | 15.9 | 57.8 | 58.8 | 55.2 | 58.3 | 26.9 | 24.7 | 20.7 | 25.8 | | Wales | 77 | 82 | 0 | 159 | 337 | 369 | 0 | 706 | 159 | 163 | 0 | 322 | | % | 13.4 | 13.4 | 0.0 | 13.4 | 58.8 | 60.1 | 0.0 | 59.5 | 27.7 | 26.5 | 0.0 | 27.1 | | England and Wales | 1,556 | 1,806 | 7 | 3,369 | 5,943 | 6,494 | 16 | 12,453 | 2,772 | 2,738 | 6 | 5,516 | | % | 15.1 | 16.4 | 24.1 | 15.8 | 57.9 | 58.8 | 55.2 | 58.4 | 27.0 | 24.8 | 20.7 | 25.9 |

Figure 10 shows the same data: percentage of children and young people with diabetes achieving the NICE recommended HbA1c targets of less than 58 mmol/mol, equal or greater than 58 mmol/mol equal or less than 80 mmol/mol, and greater than 80 mmol/mol by country in 2012-13.

Figure 10: Percentage of children and young people achieving the NICE recommended HbA1c target of \<58 mmol/mol, ≥58 mmol/mol to ≤80 mmol/mol, and >80 mmol/mol, by country in 2012-13

Table 10 shows time trends of the percentage of children and young people with diabetes by HbA1c target band achieved, for England and Wales, for 2010-11, 2011-12 and 2012-13. The percentage achieving an HbA1c of less than 58 mmol/mol in England and Wales, has decreased from 17.4% in 2011-12 to 15.8% in 2012-13. However there has been a steady decline year on year of the percentage of children and young people with an HbA1c greater than 80 mmol/mol from 28.7% in 2010-11 to 25.8% in 2012-13. Caution should be taken in the interpretation of this change, due to the difference in the analysis of HbA1c summarised above. In addition, results are not exactly comparable with those from 2010-11 where only one HbA1c value was submitted to the Audit compared to multiple HbA1cs from 2011-12 onwards.

Table 10: Percentage by HbA1c target band achieved, England and Wales in 2010-11, 2011-12 and 2012-13

| | England 2010-11 | England 2011-12 | England 2012-13 | Wales 2010-11 | Wales 2011-12 | Wales 2012-13 | England and Wales 2010-11 | England and Wales 2011-12 | England and Wales 2012-13 | |----------------|-----------------|-----------------|-----------------|---------------|---------------|---------------|---------------------------|---------------------------|---------------------------| | \<48 | 4.3 | 3.8 | 3.6 | 4.6 | 3.8 | 2.8 | 4.3 | 3.8 | 3.6 | | ≥48 and \<58 | 11.4 | 13.6 | 12.3 | 12.9 | 13.5 | 10.6 | 11.5 | 13.6 | 12.2 | | Total \<58 | 15.7 | 17.4 | 15.9 | 17.5 | 17.3 | 13.4 | 15.8 | 17.4 | 15.8 | | ≥58 and ≤80 | 55.5 | 56.2 | 58.3 | 56.8 | 55.4 | 59.5 | 55.5 | 56.2 | 58.4 | | >80 and ≤102 | 21.0 | 19.5 | 19.1 | 17.8 | 20.1 | 19.7 | 20.8 | 19.5 | 19.1 | | >102 and ≤124 | 5.6 | 5.0 | 4.7 | 6.0 | 5.3 | 5.3 | 5.7 | 5.1 | 4.8 | | >124 and ≤147 | 2.0 | 1.7 | 1.9 | 1.9 | 1.9 | 2.0 | 2.0 | 1.7 | 1.9 | | >147 and ≤169 | 0.2 | 0.1 | 0.0 | 0.0 | 0.0 | 0.1 | 0.2 | 0.1 | 0.0 | | >169 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 |

Table 11 and Figure 10 show HbA1c target band achieved (percentage and number) by ethnic group for England and Wales, in 2012-13. The ‘Asian’ and ‘Mixed’ ethnic groups have the lowest percentage achieving the target HbA1c less than 58 mmol/mol and also the greatest percentage greater than 80 mmol/mol. However, as discussed in section 4.1.2 the ethnicity ‘Not stated’ is likely being misclassified in England.

Table 11: HbA1c (mmol/mol) target band achieved (number and %) by ethnic group for England and Wales in 2012-13

| HbA1c | White | Asian | Black | Mixed | Other | Not stated | Unknown | Total | |-------|-------|-------|-------|-------|-------|------------|---------|-------| | \<58 | Number | 65 | 162 | 43 | 46 | 593 | 18 | 3,345 | | % | 15.9 | 12.5 | 15.7 | 12.0 | 16.0 | 16.3 | 18.6 | 15.8 | | ≥58 to ≤80 | Number | 9,040 | 265 | 540 | 157 | 166 | 2,127 | 54 | 12,349 | | % | 59.4 | 51.1 | 52.3 | 43.7 | 57.6 | 58.5 | 55.7 | 58.4 | | >80 | Number | 3,768 | 189 | 331 | 159 | 76 | 917 | 25 | 5,465 | | % | 24.8 | 36.4 | 32.0 | 44.3 | 26.4 | 25.2 | 25.8 | 25.8 | | Total | Number | 15,226| 519 | 1,033 | 359 | 288 | 3,637 | 97 | 21,159 | | % | 100 | 100 | 100 | 100 | 100 | 100 | 100 | 100 | Figure 11: Percentage of children and young people with diabetes by HbA1c target band achieved and ethnic group in 2012-13

Figure 12 shows percentage achievement of HbA1c target of less than 58 mmol/mol by PDU for England and Wales in 2012-13. Please refer to Appendix A for the individual Paediatric Diabetes Unit data.

Please note: where the percentage of incomplete HbA1c data is high, or the number of patients submitted low, the validity of the percentage with an HbA1c less than 58 mmol/mol for an individual PDU should be interpreted with caution, as it may not truly represent that unit’s overall outcome. Incomplete HbA1c data for a patient is defined as: no HbA1c submitted, invalid HbA1c result, no date attached to the result or date outside the Audit period.

See Appendix A for further details for each PDU. Figure 12: Percentage achievement of HbA1c target of \<58 mmol/mol by Paediatric Diabetes Unit,\* 2012-13

\*A list of PDU PZ codes and corresponding Unit names can be found in Appendix A. 6.1.2 Paediatric Diabetes unit variation in HbA1c

Table 12 shows mean and standard deviation, median and interquartile range for HbA1c for England, Wales and the English regions. Overall for England and Wales there has been no change in the mean but a decrease in the median HbA1c by 2 mmol/mol from 2011-12 to 2012-13. The change is more marked in England where the median has reduced by 2 mmol/mol with the mean remaining the same, whereas in Wales the fall in median was 1 mmol/mol with an increase in the mean of 1 mmol/mol. The mean and median values for each region in England are similar, with means ranging between 70 and 75 mmol/mol, and medians between 67 and 72 mmol/mol. This is an improvement from 2011-12 where the respective figures were between 68 and 76 mmol/mol for mean and 67 to 73 mmol/mol for median HbA1c by region. Every region within England (apart from the median in the North West and mean in South Central) has either shown an improvement or kept the same mean and median HbA1c between 2011-12 and 2012-13.

Table 12: Mean and standard deviation, median and interquartile ranges for HbA1c in mmol/mol by country and English region in 2012-13. The number in brackets in the mean and median column represents the corresponding figure for 2011-12

| Region | Mean | Median | Standard deviation | 25th percentile | 75th percentile | Interquartile range | |-------------------------|-------|--------|--------------------|-----------------|-----------------|--------------------| | England | 73 (73) | 69 (71) | 18 | 61 | 81 | 20 | | Wales | 74 (73) | 70 (71) | 18 | 62 | 81 | 20 | | England and Wales | 73 (73) | 69 (71) | 18 | 61 | 81 | 20 | | **Regions in England** | | | | | | | | East | 75 (75) | 72 (72) | 18 | 63 | 83 | 20 | | East Midlands | 70 (71) | 68 (68) | 17 | 60 | 78 | 18 | | London | 73 (74) | 70 (71) | 19 | 61 | 83 | 22 | | North East | 72 (73) | 69 (71) | 17 | 61 | 79 | 18 | | North West | 72 (72) | 69 (68) | 17 | 61 | 80 | 19 | | South Central | 70 (68) | 67 (67) | 16 | 60 | 77 | 17 | | South East | 73 (74) | 70 (71) | 18 | 62 | 81 | 19 | | South West | 72 (73) | 68 (71) | 18 | 61 | 80 | 19 | | West Midlands | 74 (76) | 71 (73) | 19 | 62 | 83 | 21 | | Yorkshire and the Humber| 72 (73) | 69 (71) | 17 | 60 | 80 | 19 |

The following box plots (Figures 13 to Figure 23) show the median, interquartile range and outlying values of HbA1c measurements by region and by PDU (refer to Appendix A for the identification of each PDU). The PDUs have been separated by the various countries and regions in England. Please note: Where the % of incomplete HbA1c data is high, or the number of submitted patients low, care must be taken in the interpretation of the results for an individual PDU. Refer to Appendix A for details of incomplete HbA1c data and patient numbers.

**Figure 13: Box and whisker plots of HbA1c by Paediatric Diabetes Unit, Wales in 2012-13**

Reference lines represent the upper and lower NICE HbA1c targets of 58 mmol/mol and 80 mmol/mol respectively.

**Figure 14: Box and whisker plots of HbA1c by Paediatric Diabetes Unit, East of England in 2012-13**

Reference lines represent the upper and lower NICE HbA1c targets of 58 mmol/mol and 80 mmol/mol respectively. Figure 15: Box and whisker plots of HbA1c by Paediatric Diabetes Unit, Yorkshire and the Humber in 2012-13

Reference lines represent the upper and lower NICE HbA1c targets of 58 mmol/mol and 80 mmol/mol respectively.

Figure 16: Box and whisker plots of HbA1c by Paediatric Diabetes Unit, East Midlands in 2012-13

Reference lines represent the upper and lower NICE HbA1c targets of 58 mmol/mol and 80 mmol/mol respectively. Figure 17: Box and whisker plots of HbA1c by Paediatric Diabetes Unit, West Midlands in 2012-13

Reference lines represent the upper and lower NICE HbA1c targets of 58 mmol/mol and 80 mmol/mol respectively.

Figure 18: Box and whisker plots of HbA1c by Paediatric Diabetes Unit, South Central in 2012-13

Reference lines represent the upper and lower NICE HbA1c targets of 58 mmol/mol and 80 mmol/mol respectively. Figure 19: Box and whisker plots of HbA1c by Paediatric Diabetes Unit, North West in 2012-13

Reference lines represent the upper and lower NICE HbA1c targets of 58 mmol/mol and 80 mmol/mol respectively.

Figure 20: Box and whisker plots of HbA1c by Paediatric Diabetes Unit, North East in 2012-13

Reference lines represent the upper and lower NICE HbA1c targets of 58 mmol/mol and 80 mmol/mol respectively. Figure 21: Box and whisker plots of HbA1c by Paediatric Diabetes Unit, South West in 2012-13

Reference lines represent the upper and lower NICE HbA1c targets of 58 mmol/mol and 80 mmol/mol respectively.

Figure 22: Box and whisker plots of HbA1c by Paediatric Diabetes Unit, London in 2012-13

Reference lines represent the upper and lower NICE HbA1c targets of 58 mmol/mol and 80 mmol/mol respectively. Figure 23: Box and whisker plots of HbA1c by Paediatric Diabetes Unit, South East in 2012-13

Reference lines represent the upper and lower NICE HbA1c targets of 58 mmol/mol and 80 mmol/mol respectively.

6.2 Funnel plots of mean HbA1c and %>80mmol/mol by Paediatric Diabetes Unit

‘Funnel plots’ are recommended as a graphical aid for institutional comparisons, in which an estimate of an underlying quantity is plotted against an interpretable measure of its precision. They are named this way because they include ‘control limits’ constructed from significance limits or confidence intervals, which form a funnel around the target outcome, in an analogy to control charts used for industrial quality improvement. They are flexible, attractively simple and avoid spurious ranking of institutions into league tables. They can be used for comparing proportions and changes in rates, assessing association between outcome and volume of cases. They have been recommended as a method of comparing healthcare providers by the National Clinical Audit Advisory Group.

Figure 24 shows a funnel plot of unadjusted mean HbA1c for PDUs in England and Wales, obtained from the unit mean of individual patient median HbA1c values. PDUs can be identified using Appendix B which provides the unit size and unadjusted mean HbA1c which can be used as x and y coordinates to find an individual unit. The limits for the outliers have been set as 5% and 2% which was recommended by the National Clinical Audit Advisory Group. These limits represent an ‘alert’ or an ‘alarm’ respectively for the performance indicator of an individual unit. The National Clinical Audit Advisory Group also recommends that funnel plots should be statistically adjusted to take account of ‘casemix’ variation between providers’ treatment populations. Adjustment is a method of dealing with over-dispersion in the raw data due to unmeasured risk factors i.e. patient characteristics. NPDA data contains some, but by no means all, the patient risk factors which may affect target achievement. Table 13 shows a multivariate multiple regression analysis of patient risk/predictive factors for HbA1c. A negative regression coefficient denotes a negative effect on the outcome and vice versa for a positive coefficient. The proportion of the variance in values explained by a regression model is given by the R-squared statistic. The R-squared for this model is 0.083 i.e. the variables included explains 8.3% of the variance. Table 13: Multiple regression showing the predictive risk factors for patient HbA1c in England and Wales in 2012-13

| HbA1c value (mmol/mol) | Coef. | 95% Confidence interval | p-value | Std. Err. | |------------------------|-------|-------------------------|---------|-----------| | Age (years) | 0.92 | [0.86-0.99] | \<0.001 | 0.03 | | Gender | | | | | | Male | 0 | | | | | Female | 1.12 | [0.66-1.58] | \<0.001 | 0.23 | | Not specified | -2.86 | [-9.14-3.43] | 0.373 | 3.21 | | Ethnicity | | | | | | White | 0 | | | | | Asian | 4.96 | [3.46-6.47] | \<0.001 | 0.77 | | Black | 0.79 | [-0.31-1.88] | 0.160 | 0.56 | | Mixed | 5.54 | [3.74-7.35] | \<0.001 | 0.92 | | Other | 0.28 | [-1.74-2.3] | 0.786 | 1.03 | | Not stated | 0.04 | [-0.57-0.66] | 0.890 | 0.32 | | Unknown | 0.67 | [-1.38-2.73] | 0.521 | 1.05 | | Deprivation (quintiles)| | | | | | 1st | 0 | | | | | 2nd | 1.18 | [0.46-1.89] | 0.001 | 0.37 | | 3rd | 3.22 | [2.49-3.94] | \<0.001 | 0.37 | | 4th | 5.34 | [4.61-6.06] | \<0.001 | 0.37 | | 5th | 5.73 | [5.01-6.46] | \<0.001 | 0.37 | | Duration of diabetes (years) | 0.39 | [0.33-0.44] | \<0.001 | 0.37 | | Constant | 55.28 | [54.35-56.21] | \<0.001 | 0.48 |

The results of the regression modelling can be used to predict HbA1c values for each patient using the significant risk factors in Table 13. Figure 25 shows a funnel plot of the adjusted mean HbA1c by PDU which takes into account the ‘casemix’ for each individual PDU. PDUs can be identified using Appendix B which provides the unit size and adjusted mean HbA1c which can be used as x and y coordinates to find an individual unit. The adjusted mean HbA1c in this model does not take into account the effect of any remaining unmeasured risk factors, which we know from the R-squared value comprise the majority of the variance. If the variables used for adjustment only explain a small proportion of the differences in patients’ HbA1c, the adjusted values will show less variation than the observed values but more than would be present if data was included for all risk factors. This is because many other risk factors are contributing to the variance which has not been included in the model. The reduction in dispersion can be seen by comparing Figure 25 to Figure 24. By reference to Appendix B individual PDUs can obtain their unadjusted and adjusted mean HbA1c. The adjusted mean HbA1c gives a measure of performance taking into account the significant variables in the population that influence it. For some units this influences where they lie within the funnel plot and whether they are defined as an outlier or not.

\**Figure 25: Funnel plot showing the adjusted mean HbA1c for PDUs in England and Wales by unit size in 2012-13*.\*\*

In a similar manner to using the mean HbA1c for a PDU, funnel plots for thresholds can be created using pre-defined ‘cut-offs’. Figure 26 shows a funnel plot of the unadjusted proportion of patients with an HbA1c above 80 mmol/mol. PDUs can be identified using Appendix B, which provides the unit size and unadjusted percentage of patients with an HbA1c greater than 80 mmol/mol which can be used as x and y coordinates to find an individual unit. Using a threshold which has been adjusted in the same way as mean HbA1c is problematic because of the reduction in variation mentioned above. An alternative is to fit a logistic regression model, which can be used to predict the probability that HbA1c levels meet or do not meet a defined threshold.

Table 14 displays a logistic regression model of risk factors for the proportion of children and young people with diabetes with an HbA1c greater than 80 mmol/mol. Logistic regression generates odds ratios (ORs) rather than regression coefficients; an OR of unity means there is no effect, an OR greater than 1 means an increase in the outcome, and vice versa for an OR less than 1. The R-squared for this model is 0.071 i.e. 7.1% of the variability is explained by the variables in the model. Table 14: Logistic regression model of risk factors for proportion of children and young people with diabetes in England and Wales with an HbA1c greater than 80 mmol/mol in 2012-13

| Above 80 (mmol/mol) | Odds Ratio | 95% Confidence interval | p-value | Std. Err. | |---------------------|------------|-------------------------|---------|-----------| | Age (years) | 1.17 | [1.15-1.18] | \<0.001 | 0.01 | | Gender | | | | | | Male | 1 | | | | | Female | 1.13 | [1.06-1.21] | \<0.001 | 0.04 | | Not specified | 1.00 | [0.39-2.53] | 0.992 | 0.47 | | Ethnicity | | | | | | White | 1 | | | | | Asian | 1.83 | [1.51-2.22] | \<0.001 | 0.18 | | Black | 1.30 | [1.12-1.51] | \<0.001 | 0.10 | | Mixed | 2.27 | [1.82-2.85] | \<0.001 | 0.26 | | Other | 1.01 | [0.76-1.34] | 0.947 | 0.14 | | Not stated | 1.04 | [0.96-1.14] | 0.340 | 0.05 | | Unknown | 1.15 | [0.87-1.53] | 0.325 | 0.17 | | Deprivation (quintiles) | | | | | | 1st | 1 | | | | | 2nd | 1.18 | [1.06-1.32] | 0.003 | 0.07 | | 3rd | 1.58 | [1.42-1.76] | \<0.001 | 0.09 | | 4th | 2.06 | [1.86-2.29] | \<0.001 | 0.11 | | 5th | 2.15 | [1.93-2.38] | \<0.001 | 0.11 | | Duration of diabetes (years) | 1.03 | [1.0196-1.0351] | \<0.001 | 0.00 |

Figure 27 shows a funnel plot of the casemix adjusted proportion of children and young people with diabetes with an HbA1c value greater than 80 mmol/mol. PDUs can be identified using Appendix B which provides the unit size and adjusted percentage of patients with an HbA1c greater than 80 mmol/mol which can be used as x and y coordinates to find an individual Unit and its unadjusted and adjusted percentage of patients with HbA1c greater than 80 mmol/mol. The adjusted value gives a measure of performance taking into account the significant variables in the population that influence it. For some units this influences where they lie within the funnel plot and whether they are defined as an outlier or not. Figure 27: Funnel plot showing the adjusted proportion (%) of children and young people with diabetes in England and Wales with HbA1c greater than 80 mmol/mol against unit size in 2012-13\*

\*Refer to Appendix B to identify an individual PDU. 7. Conclusions and recommendations

The results from this 2012-13 NPDA report for England and Wales indicates that those delivering care to children and young people with diabetes are developing strategies demonstrating quality improvement. There have been significant improvements in the recording of individual care processes, albeit that the proportion of patients receiving all seven care processes is still extremely low. The median HbA1c has fallen by 2 mmol/mol since 2011-12, with this rate of fall being consistent with those identified in other European countries in which improvements have already taken place. Furthermore, this now represents the third year where there has been a fall in median HbA1c. Casemix adjustment in mean HbA1c and percentage of patients with poor outcomes (greater than 80 mmol/mol) for each PDU have been reported for the first time in 2012-13, allowing PDUs to observe their outlier status before and after adjustment for their patient characteristics. However, the models of adjustment can only take into account those patient related variables that are collected by the NPDA. For mean HbA1c the model only accounts for just over 8% of the variability and for the proportion of patients with an HbA1c >80mmol/mol the model only accounts for just over 7% of the variability. Clearly, therefore over 90% of the variability in outcome must be explained by service related factors such as structure, resource and delivery of care.

It is likely that the improvements demonstrated in this report have been achieved by the concerted efforts of all PDUs to engage in the work of their regional diabetes networks. The peer review quality assurance programme has facilitated the sharing of all the good practices that influence improved outcomes and it has facilitated their early adoption across the nation. This should lead to a reduction in the variability in outcomes. In England, the Best Practice Tariff introduced in 2012 will undoubtedly start to provide the ability to financially resource PDUs in a manner that will provide improved quality of care. It is still probably too early for the 2012-13 NPDA data collection and report to demonstrate the influence that its introduction may have had. Furthermore, any change is going to be slow as the population of children and young people with diabetes in England and Wales is large.

The peer review quality assurance programme, which will complete its first round of site visits for both England and Wales by the end of 2014, will be able to help PDU’s to identify their strengths and weaknesses, and encourage all PDUs to develop ongoing work plans to drive up quality of care. All PDUs should utilise the data provided in this report in a positive manner. In addition, discussions and actions at both local and regional network level should be employed to develop the strategies that will lead to the delivery of better quality care and improved outcomes. These will continue to be measured by ongoing participation in the NPDA.

Despite the improvements demonstrated in the report, it is not the time to rest on our laurels. There is clearly much work to be done to reduce variability and improve outcomes across England and Wales. PDUs and all healthcare professionals involved in the care of children and young people with diabetes have a responsibility to ensure optimal achievable outcomes for their patients so they can live as normal, and complication free, lifestyles as possible. 8. Acknowledgements and collaborators

National Paediatric Diabetes Audit Project Board

- Dr Jeremy Allgrove, Consultant Paediatric Endocrinologist, Barts Health NHS Trust (IT Solutions Adviser)
- Ms Katie Beddows, Paediatric Diabetes Specialist Nurse, Stockport NHS Foundation Trust (Senior User)
- Dr Fiona Campbell, Consultant Paediatric Diabetologist, Leeds Teaching Hospitals NHS Trust
- Ms Kate Fazakerley, Parent representative
- Dr Michael Soljak, Clinical Research Fellow, Imperial College London
- Dr Justin Warner, Clinical Lead, RCPCH and Consultant in Paediatric Endocrinology and Diabetes, University of Wales Hospital

Project Management

- Mr Siôn Morris, Project Manager, RCPCH,
- Dr Alison Elderfield, Project Manager, RCPCH
- Ms Tyler Moorehead, Programme Manager, RCPCH

Project Support

- Ms Naima Hussein, Project Administrator, RCPCH
- Ms Melanie David-Feveck, Project Administrator, RCPCH

Data Analysis

- Dr Michael Soljak (Clinical Research Fellow, Imperial College London)
- Emilie Kottenmeier (Research Assistant, Imperial College London)

National Paediatric Diabetes Audit Dataset Working Group

- Dr Fiona Campbell, Consultant Paediatric Diabetologist, Leeds Teaching Hospitals NHS Trust (Chair)
- Dr Rakesh Amin, Consultant in Paediatric and Adolescent Endocrinology and Diabetes, Great Ormond Street Hospital for Children NHS Trust
- Dr James Greening, Consultant Paediatric Endocrinologist and Diabetologist, University Hospitals Leicester NHS Trust
- Dr Piyusha Kapila, Consultant Paediatrician, North Middlesex University Hospital NHS Trust
- Ms Helen Thornton, Paediatric Diabetes Specialist Nurse, St Helens and Knowsley Teaching Hospitals NHS Trust

National Paediatric Diabetes Audit Patient Reported Experience and Outcome Measures Working Group

- Dr Deborah Christie, Consultant Clinical Psychologist and Reader in Paediatric and Adolescent Psychology, University College London Hospitals NHS Foundation Trust (Chair)
- Ms Judith Campbell, Paediatric Diabetes Specialist Nurse, Central Manchester University Hospitals NHS Foundation Trust
- Ms Kate Fazakerley, Parent representative
- Professor Peter Hindmarsh, Professor of Paediatric Endocrinology, University College London • Mr Neil Musgrove, Parent representative • Dr Shakeel Rahman, Consultant Paediatrician, Harrogate Health Care NHS Trust • Dr Nicola Trevelyan, Consultant Paediatrician, Southampton University Hospitals NHS Trust

National Paediatric Diabetes Audit Collaborators • Association of Children's Diabetes Clinicians • British Dietetic Association • The British Psychological Society • British Society for Paediatric Endocrinology and Diabetes • Diabetes UK • Royal College of Nursing • Juvenile Diabetes Research Foundation (JDRF) 9. References

1. National Institute for Health and Clinical Excellence. Diagnosis and management of Type 1 diabetes in children, young people and adults: National Institute for Health and Clinical Excellence, 2004.

2. Health and Social Care Information Centre. National Diabetes Audit 2011–2012 Report 1: Care Processes and Treatment Targets. Leeds: Health and Social Care Information Centre, 2013.

3. Spiegelhalter DJ. Funnel plots for comparing institutional performance. Statistics in Medicine 2005;24(8):1185-202 doi: 10.1002/sim.1970 [published Online First: Epub Date].

4. National Clinical Audit Advisory Group. Detection and management of outliers: guidance prepared by National Clinical Audit Advisory Group: Healthcare Quality Improvement Partnership, 2011.

5. Department of Health. National Service Framework for Diabetes: London: Department of Health, 2001. Appendix A: Data on Paediatric Diabetes Units in the 2012-13 National Paediatric Diabetes Audit

**NOTE:** Where the percentage of incomplete HbA1c data is high, or the number of patients submitted low, the validity of the percentage with an HbA1c \<58 mmol/mol (7.5%), mean and median HbA1c for an individual Paediatric Diabetes Unit should be interpreted with caution, as it may not truly represent that unit’s overall outcome. Incomplete data is defined as: no HbA1c submitted, invalid HbA1c result, no date attached to the result or date outside the Audit period. HbA1c result less than 3 months from diagnosis are not included in the analysis.

\*Eligible patients were those greater than 3 month post diagnosis.

\*\*For HbA1c to be included in the analysis the patient needed a valid date of diagnosis, a valid submitted value and a date of submission which was within the Audit year. Where more than one HbA1c was submitted for a patient the median value was used for the Audit year.

| PDU code | PDU Name | Total no. of patients submitted to NPDA | Total no. of patients eligible for HbA1c analysis\* | Patients used for HbA1c outcome analysis \*\* | Patients excluded from HbA1c outcome analysis | % excluded from HbA1c outcome analysis | % with HbA1c < 58 mmol/mol | Mean HbA1c (mmol/mol) | Median HbA1c (mmol/mol) | % of incomplete records of care processes except Hba1c | |----------|--------------------------------------------------------------------------|----------------------------------------|---------------------------------------------------|---------------------------------------------|---------------------------------------------|--------------------------------------|----------------------------|------------------------|------------------------|---------------------------------------------| | PZ001 | Singleton Hospital, Abertawe Bro Morgannwg University Health Board, Wales | 136 | 133 | 108 | 25 | 18.8% | 12.0% | 70.3 | 69.4 | 30.6% | | PZ002 | Norfolk and Norwich University Hospital, Norfolk and Norwich University Hospital Trust, East of England | 88 | 84 | 56 | 28 | 33.3% | 12.5% | 73.9 | 68.8 | 22.3% | | PZ004 | Northampton General Hospital, Northampton General Hospital NHS Trust, East Midlands | 211 | 211 | 172 | 39 | 18.5% | 12.8% | 72.8 | 68.0 | 39.2% | | PZ005 | Derbyshire Children’s Hospital, Derby Hospitals NHS Foundation Trust, East Midlands | 257 | 254 | 223 | 31 | 12.2% | 20.6% | 70.0 | 68.0 | 29.1% | | PZ006 | Doncaster Royal Infirmary, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Yorkshire and the Humber | 148 | 145 | 123 | 22 | 15.2% | 29.3% | 66.2 | 64.5 | 23.4% | | PZ007 | John Radcliffe Hospital, Oxford | 344 | 340 | 299 | 41 | 12.1% | 29.8% | 64.0 | 63.0 | 29.0% | | PDU Code | PDU Name | Total no. of patients submitted to NPDA | Total no. of patients eligible for HbA1c analysis\* | Patients used for HbA1c outcome analysis \*\* | Patients excluded from HbA1c outcome analysis | % of incomplete records of care processes except HbA1c | Mean HbA1c (mmol/mol) | Median HbA1c (mmol/mol) | % with HbA1c\<58 mmol/mol | Mean HbA1c (mmol/mol) | Median HbA1c (mmol/mol) | % with HbA1c\<58 mmol/mol | % excluded from HbA1c outcome analysis | |----------|----------|----------------------------------------|--------------------------------------------------|---------------------------------------------|---------------------------------------------|-------------------------------------------------|------------------------|------------------------|--------------------------|------------------------|------------------------|--------------------------|----------------------------------| | PZ009 | Radcliffe Hospitals NHS Trust, South Central | 96 | 95 | 11 | 11.6% | 21.4% | 69.9 | 66.3 | 30.1% | 38.9% | 39.9% | 56.4% | 11.6% | | PZ010 | Macclesfield District General Hospital, East Cheshire NHS Trust, North West | 121 | 116 | 10 | 8.6% | 11.3% | 75.5 | 72.1 | 38.9% | 39.9% | 56.4% | 56.1% | 11.6% | | PZ011 | Luton and Dunstable Hospital, Luton and Dunstable Hospital NHS Foundation Trust, East of England | 126 | 126 | 105 | 16.7% | 4.8% | 80.3 | 78.0 | 39.9% | 39.9% | 56.4% | 56.1% | 11.6% | | PZ012 | Glan Clwyd District General Hospital, Best Caderfyl University Health Board, Wales | 75 | 75 | 75 | 0 | 0.0% | 6.7% | 76.2 | 70.5 | 56.4% | 56.1% | 56.1% | 11.6% | | PZ013 | Barnet Hospital, Barnet and Chase Farm Hospitals NHS Trust, London and South East | 55 | 47 | 6 | 11.3% | 12.8% | 76.5 | 73.0 | 39.9% | 39.9% | 56.4% | 56.1% | 11.6% | | PZ014 | Chase Farm Hospital, Barnet and Chase Farm Hospitals NHS Trust, London and South East | 90 | 89 | 55 | 38.2% | 10.9% | 70.7 | 67.2 | 39.9% | 39.9% | 56.4% | 56.1% | 11.6% | | PZ015 | Wythenshawe Hospital, University Hospital of South Manchester NHS Foundation Trust, North West | 67 | 65 | 58 | 10.8% | 24.1% | 71.2 | 68.3 | 39.9% | 39.9% | 56.4% | 56.1% | 11.6% | | PZ016 | Basildon Hospital, Basildon and Thurrock University Hospitals NHS Foundation Trust, East of England | 94 | 92 | 83 | 9.8% | 20.5% | 70.6 | 66.1 | 39.9% | 39.9% | 56.4% | 56.1% | 11.6% | | PZ017 | Worthing Hospital, Western Sussex Hospitals NHS Trust, London and South East | 130 | 129 | 118 | 8.5% | 12.7% | 76.4 | 71.9 | 39.9% | 39.9% | 56.4% | 56.1% | 11.6% | | PZ018 | Basildon Hospital, Basildon and Thurrock University Hospitals NHS Foundation Trust, East of England | 234 | 232 | 201 | 13.4% | 10.5% | 75.0 | 72.7 | 39.9% | 39.9% | 56.4% | 56.1% | 11.6% | | PDU code | PDU Name | Total no. of patients submitted to NPDA | Total no. of patients eligible for HbA1c analysis\* | Patients used for HbA1c outcome analysis \*\* | Patients excluded from HbA1c outcome analysis | % excluded from HbA1c outcome analysis | % with HbA1c < 58 mmol/mol | Mean HbA1c (mmol/mol) | Median HbA1c (mmol/mol) | % of incomplete records of care processes except Hba1c | |----------|--------------------------------------------------------------------------|----------------------------------------|---------------------------------------------------|---------------------------------------------|---------------------------------------------|--------------------------------------|----------------------------|------------------------|------------------------|----------------------------------| | PZ020 | Diana Princess Of Wales Hospital, Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, Yorkshire and the Humber | 114 | 113 | 93 | 20 | 17.7% | 11.8% | 78.6 | 76.0 | 30.6% | | PZ021 | Wexham Park Hospital, Heatherwood and Wexham Park Hospitals Trust, South Central | 167 | 165 | 139 | 26 | 15.8% | 20.1% | 71.5 | 68.0 | 39.1% | | PZ022 | West Cumberland Hospital, North Cumbria University Hospitals NHS Trust, North West | 38 | 36 | 34 | 2 | 5.6% | 5.9% | 76.5 | 68.7 | 64.8% | | PZ023 | St George's Hospital, St George's Healthcare NHS Trust, London and South East | 118 | 117 | 0 | 117 | 100.0% | NO DATA | NO DATA | NO DATA | 92.9% | | PZ024 | East Kent Hospitals NHS Trust, East Kent Hospitals University NHS Foundation Trust, London and South East | 327 | 325 | 281 | 44 | 13.5% | 13.2% | 74.9 | 72.0 | 16.0% | | PZ026 | Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust, Yorkshire and the Humber | 258 | 256 | 230 | 26 | 10.2% | 11.7% | 75.4 | 71.0 | 67.3% | | PZ027 | Friarage Hospital, South Tees Hospitals NHS Trust, Yorkshire and the Humber/ North East | 64 | 60 | 55 | 5 | 8.3% | 18.2% | 69.9 | 70.0 | 34.7% | | PZ028 | Stoke Mandeville Hospital, Buckinghamshire Hospitals NHS Trust, South Central | 95 | 90 | 77 | 13 | 14.4% | 11.7% | 73.9 | 70.0 | 19.1% | | PZ030 | Leighton Hospital, Mid-Cheshire Hospitals NHS Trust, North West | 110 | 107 | 98 | 9 | 8.4% | 26.5% | 65.5 | 64.0 | 40.7% | | PZ031 | St Richard's Hospital, Western Sussex Hospitals NHS Trust, London and South | 88 | 88 | 81 | 7 | 8.0% | 8.6% | 74.0 | 72.7 | 45.3% | | PDU code | PDU Name | Total no. of patients submitted to NPDA | Total no. of patients eligible for HbA1c analysis\* | Patients used for HbA1c outcome analysis \*\* | Patients excluded from HbA1c outcome analysis | % excluded from HbA1c outcome analysis | % with HbA1c < 58 mmol/mol | Mean HbA1c (mmol/mol) | Median HbA1c (mmol/mol) | % of incomplete records of care processes except HbA1c | |----------|--------------------------------------------------------------------------|----------------------------------------|---------------------------------------------------|---------------------------------------------|---------------------------------------------|--------------------------------------|----------------------------|------------------------|------------------------|---------------------------------------------| | PZ032 | East, Royal Victoria Infirmary, The Newcastle Upon Tyne Hospital Trust, North East | 322 | 318 | 283 | 35 | 11.0% | 15.6% | 71.8 | 67.7 | 41.4% | | PZ033 | Queens Hospital, Burton Hospitals NHS Trust, West Midlands | 115 | 114 | 105 | 9 | 7.9% | 9.5% | 72.3 | 69.4 | 55.8% | | PZ034 | Royal Hampshire County Hospital, Winchester and Eastleigh Healthcare NHS Trust, South Central | 143 | 139 | 124 | 15 | 10.8% | 12.9% | 73.3 | 69.0 | 58.7% | | PZ035 | Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, South Central | 251 | 244 | 209 | 35 | 14.3% | 24.4% | 67.2 | 64.0 | 34.9% | | PZ036 | Whipp Cross University Hospital, Whipp Cross University NHS Trust, London and South East | 121 | 121 | 98 | 23 | 19.0% | 13.3% | 71.0 | 67.5 | 27.1% | | PZ038 | Wycombe General, Buckinghamshire Hospitals NHS Trust, South Central | 114 | 113 | 102 | 11 | 9.7% | 11.8% | 75.5 | 72.8 | 13.7% | | PZ040 | Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, West Midlands | 242 | 242 | 207 | 35 | 14.5% | 8.2% | 80.2 | 77.1 | 60.7% | | PZ041 | Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, East of England | 276 | 256 | 239 | 17 | 6.6% | 11.7% | 74.0 | 70.0 | 45.5% | | PZ042 | Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, East Midlands | 293 | 293 | 264 | 29 | 9.9% | 28.8% | 65.6 | 65.0 | 57.5% | | PZ045 | Whittington Hospital, Whittington Hospital NHS Trust, London and South East | 66 | 65 | 56 | 9 | 13.8% | 8.9% | 81.2 | 76.0 | 57.3% | | PZ047 | Airedale General Hospital, Whittington | 74 | 73 | 66 | 7 | 9.6% | 10.6% | 70.2 | 67.0 | 28.3% | | PDU code | PDU Name | Total no. of patients submitted to NPDA | Total no. of patients eligible for HbA1c analysis\* | Patients used for HbA1c outcome analysis | Patients excluded from HbA1c outcome analysis | % excluded from HbA1c outcome analysis | % with HbA1c\<58 mmol/mol | Mean HbA1c (mmol/mol) | Median HbA1c (mmol/mol) | % of incomplete records of care processes except HbA1c | |----------|--------------------------------------------------------------------------|----------------------------------------|---------------------------------------------------|------------------------------------------|---------------------------------------------|--------------------------------------|----------------------------|------------------------|------------------------|---------------------------------------------| | PZ048 | Hospital NHS Trust, Yorkshire and the Humber | 121 | 120 | 107 | 13 | 10.8% | 14.0% | 72.9 | 70.0 | 49.7% | | PZ049 | Lincoln County Hospital, United Lincolnshire Hospitals NHS Trust, East Midlands | 155 | 151 | 140 | 11 | 7.3% | 20.0% | 67.4 | 66.3 | 21.7% | | PZ050 | Warrington General Hospital, Warrington and Halton Hospitals NHS Foundation Trust, North West | 120 | 122 | 101 | 21 | 17.2% | 11.9% | 78.0 | 75.0 | 11.9% | | PZ052 | Queen Mary's Hospital for Children, Epsom and St Helier Trust, London and South East | 92 | 91 | 66 | 25 | 27.5% | 12.1% | 76.2 | 75.5 | 38.2% | | PZ053 | Scunthorpe General Hospital, Northern Lincolnshire and Goole Hospitals NHS Foundation Trust, Yorkshire and the Humber | 101 | 99 | 79 | 20 | 20.2% | 11.4% | 74.3 | 73.0 | 16.1% | | PZ054 | Poole General Hospital, Poole Hospital NHS Trust, South Central | 194 | 193 | 161 | 32 | 16.6% | 14.9% | 70.1 | 68.0 | 27.8% | | PZ055 | Leicester Royal Infirmary, University Hospitals Leicester NHS Trust, East Midlands | 385 | 380 | 325 | 55 | 14.5% | 10.5% | 73.6 | 69.4 | 0.0% | | PZ056 | West Wales General Hospital, Hywel Dda Health Board, Wales | 73 | 70 | 56 | 14 | 20.0% | 14.3% | 69.1 | 67.2 | 8.6% | | PZ057 | Kingston Hospital, Kingston Hospital NHS Trust, London and South East | 153 | 149 | 132 | 17 | 11.4% | 22.7% | 65.7 | 63.8 | 82.1% | | PZ058 | Newham General Hospital, Newham University Hospital NHS Trust, London and South East | 109 | 108 | 90 | 18 | 16.7% | 11.1% | 79.0 | 79.0 | 30.5% | | PDU code | PDU Name | Total no. of patients submitted to NPDA | Total no. of patients eligible for HbA1c analysis\* | Patients used for HbA1c outcome analysis \*\* | Patients excluded from HbA1c outcome analysis | % excluded from HbA1c\<58 mmol/mol | Mean HbA1c (mmol/mol) | Median HbA1c (mmol/mol) | % of incomplete records of care processes except HbA1c | |----------|--------------------------------------------------------------------------|----------------------------------------|---------------------------------------------------|---------------------------------------------|---------------------------------------------|----------------------------------|----------------------|----------------------|---------------------------------------------| | PZ059 | The Royal London Hospital, Barts and the London NHS Trust, London and South East | 195 | 190 | 161 | 29 | 15.3% | 22.4% | 70.0 | 67.0 | 39.3% | | PZ060 | Royal Devon and Exeter, Royal Devon and Exeter NHS Foundation Trust, South West | 190 | 187 | 159 | 28 | 15.0% | 10.1% | 75.8 | 72.0 | 100.0% | | PZ062 | Croydon University Hospital, Croydon Health Services NHS Trust, London and South East | 96 | 93 | 83 | 10 | 10.8% | 10.8% | 75.4 | 73.0 | 10.2% | | PZ064 | Chesterfield Royal Hospital, Chesterfield Royal Hospital NHS Foundation Trust, East Midlands | 136 | 136 | 112 | 24 | 17.6% | 13.4% | 71.5 | 70.2 | 30.8% | | PZ065 | Staffordshire General Hospital, Mid-Staffordshire NHS Foundation Trust, West Midlands | 113 | 111 | 104 | 7 | 6.3% | 13.5% | 76.3 | 71.0 | 64.3% | | PZ067 | Royal Cornwall Hospital, Royal Cornwall Hospitals NHS Trust, South West | 204 | 202 | 17 | 185 | 91.6% | 23.5% | 71.6 | 66.0 | 21.3% | | PZ068 | Royal United Bath Hospital, Royal United Hospital Bath NHS Trust, South West | 212 | 210 | 175 | 35 | 16.7% | 14.3% | 75.6 | 72.0 | 17.4% | | PZ069 | Stepping Hill Hospital, Stockport NHS Foundation Trust, North West | 140 | 138 | 122 | 16 | 11.6% | 20.5% | 68.1 | 66.0 | 61.0% | | PZ072 | West Suffolk Hospital, West Suffolk Hospital NHS Trust, East of England | 129 | 127 | 108 | 19 | 15.0% | 20.4% | 67.1 | 65.6 | 54.7% | | PZ073 | Alexandra Hospital, Worcestershire Acute Hospitals NHS Trust, West Midlands | 93 | 93 | 83 | 10 | 10.8% | 7.2% | 74.6 | 71.0 | 29.7% | | PZ074 | Alder Hey Hospital, Alder Hey Children's NHS Foundation Trust, North | 248 | 246 | 211 | 35 | 14.2% | 16.6% | 72.4 | 69.0 | 25.4% | | PDU code | PDU Name | Total no. of patients submitted to NPDA | Total no. of patients eligible for HbA1c analysis\* | Patients used for HbA1c outcome analysis | Patients excluded from HbA1c outcome analysis | % excluded from HbA1c outcome analysis | % with HbA1c < 58 mmol/mol | Mean HbA1c (mmol/mol) | Median HbA1c (mmol/mol) | % of incomplete records of care processes except HbA1c | |----------|--------------------------------------------------------------------------|----------------------------------------|---------------------------------------------------|------------------------------------------|---------------------------------------------|--------------------------------------|----------------------------|------------------------|------------------------|----------------------------------------------------------| | PZ075 | West St. Mary's Hospital, Isle of Wight Healthcare NHS Trust, South Central | 53 | 53 | 45 | 8 | 15.1% | 17.8% | 75.7 | 68.3 | 38.5% | | PZ076 | Colchester General Hospital, Colchester Hospital University NHS Foundation Trust, East of England | 189 | 179 | 167 | 12 | 6.7% | 1.2% | 81.6 | 80.3 | 11.1% | | PZ078 | North Staffordshire Hospital, University Hospital of North Staffordshire NHS Trust, West Midlands | 220 | 220 | 189 | 31 | 14.1% | 12.2% | 75.0 | 72.1 | 51.0% | | PZ080 | Sunderland Royal Hospital, City Hospitals Sunderland NHS Trust, North East | 167 | 169 | 149 | 20 | 11.8% | 16.1% | 68.5 | 66.0 | 29.5% | | PZ082 | Evelina Children’s Hospital at St Thomas Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London and South East | 94 | 94 | 83 | 11 | 11.7% | 8.4% | 81.8 | 78.7 | 40.6% | | PZ084 | Kidderminster General Hospital, Worcestershire Acute Hospitals NHS Trust, West Midlands | 63 | 63 | 59 | 4 | 6.3% | 17.0% | 75.7 | 69.5 | 24.3% | | PZ085 | Princess Royal University Hospital, Bromley, South London Healthcare NHS Trust, London and South East | 112 | 103 | 88 | 15 | 14.6% | 17.1% | 69.2 | 66.1 | 27.4% | | PZ086 | Hinchingbrooke Hospital, Hinchingbrooke Health Care NHS Trust, East of England | 96 | 96 | 83 | 13 | 13.5% | 8.4% | 73.5 | 71.6 | 48.8% | | PZ088 | Royal Surrey County Hospital, The Royal Surrey County Hospital NHS Foundation Trust, London and South East | 51 | 50 | 42 | 8 | 16.0% | 35.7% | 61.7 | 59.3 | 97.8% | | PDU Code | PDU Name | Total no. of patients submitted to NPDA | Total no. of patients eligible for HbA1c analysis\* | Patients used for HbA1c outcome analysis \*\* | Patients excluded from HbA1c outcome analysis | % of incomplete records of care processes except HbA1c | Mean HbA1c (mmol/mol) | Median HbA1c (mmol/mol) | % with HbA1c\<58 mmol/mol | Mean HbA1c (mmol/mol) | Median HbA1c (mmol/mol) | % with HbA1c\<58 mmol/mol | % excluded from HbA1c outcome analysis | |---------|--------------------------------------------------------------------------|----------------------------------------|---------------------------------------------------|---------------------------------------------|---------------------------------------------|------------------------------------------------|------------------------|------------------------|---------------------------------|------------------------|------------------------|---------------------------------|----------------------------------| | PZ089 | Northwick Park Hospital, North West London and South East | 106 | 104 | 21 | 83.2 | 62.1% | 81.0 | 71.2 | 14.3% | 74.0 | 67.3 | 24.1% | 14.5% | | PZ090 | Pontefract General Infirmary, The Mid-Yorkshire Hospitals NHS Trust, Yorkshire and the Humber | 190 | 187 | 172 | 8.0% | 14.5% | 71.2 | 15.8% | 14.5% | 71.2 | 14.5% | 14.5% | 14.5% | | PZ091 | East Lancashire Diabetic Service, East Lancashire Hospitals NHS Trust, North West | 262 | 260 | 222 | 14.6% | 15.8% | 71.5 | 15.8% | 15.8% | 71.5 | 15.8% | 15.8% | 15.8% | | PZ092 | Princess of Wales Hospital, Abergavenny, Bro Morgannwg University Health | 81 | 81 | 73 | 9.9% | 16.4% | 73.0 | 16.4% | 16.4% | 73.0 | 16.4% | 16.4% | 16.4% | | PZ093 | The Princess Royal, Royal Shrewsbury Hospital NHS Trust, West Midlands | 260 | 257 | 225 | 12.5% | 16.0% | 66.4 | 16.0% | 16.0% | 66.4 | 16.0% | 16.0% | 16.0% | | PZ094 | Derriford Hospital, Plymouth Hospitals NHS Trust, South West | 176 | 175 | 153 | 12.6% | 12.6% | 72.7 | 12.6% | 12.6% | 72.7 | 12.6% | 12.6% | 12.6% | | PZ095 | City Hospital Birmingham, Sandwell and West Birmingham Hospitals NHS Trust, West Midlands | 65 | 65 | 34 | 17.6% | 17.6% | 65.0 | 17.6% | 17.6% | 65.0 | 17.6% | 17.6% | 17.6% | | PZ096 | East and North Herts NHS Trust, The Lister, Queen Elizabeth II, The Lister, East and North Herts NHS Trust, East of England | 225 | 222 | 216 | 2.7% | 13.9% | 68.3 | 2.7% | 2.7% | 68.3 | 2.7% | 2.7% | 2.7% | | PZ097 | North Devon District Hospital, Northern Devon Healthcare NHS Trust, South West | 86 | 86 | 70 | 18.6% | 18.6% | 69.6 | 18.6% | 18.6% | 69.6 | 18.6% | 18.6% | 18.6% | | PZ098 | Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Yorkshire and the Humber | 350 | 337 | 295 | 12.5% | 12.5% | 67.1 | 12.5% | 12.5% | 67.1 | 12.5% | 12.5% | 12.5% | | PZ099 | Hillingdon Hospital, Hillingdon Hospital | 153 | 143 | 131 | 8.4% | 8.4% | 76.5 | 8.4% | 8.4% | 76.5 | 8.4% | 8.4% | 8.4% | | PDU code | PDU Name | Total no. of patients submitted to NPDA | Total no. of patients eligible for HbA1c analysis\* | Patients used for HbA1c outcome analysis \*\* | Patients excluded from HbA1c outcome analysis | % excluded from HbA1c\<58 mmol/mol | Mean HbA1c (mmol/mol) | Median HbA1c (mmol/mol) | % of incomplete records of care processes except HbA1c | |----------|--------------------------------------------------------------------------|----------------------------------------|---------------------------------------------------|---------------------------------------------|---------------------------------------------|----------------------------------|----------------------|----------------------|-----------------------------------------------| | PZ104 | NHS Trust, London and South East | 126 | 124 | 107 | 17 | 13.7% | 17.8% | 74.8 | 71.6 | 35.2% | | PZ105 | Royal Albert Edward Infirmary, Wrightington, Wigan and Leigh NHS Foundation Trust, North West | 195 | 193 | 156 | 37 | 19.2% | 12.8% | 76.9 | 75.5 | 56.2% | | PZ106 | Victoria Hospital, Blackpool, Fylde and Wyre Hospitals NHS Trust, North West | 112 | 111 | 94 | 17 | 15.3% | 17.0% | 70.4 | 69.8 | 51.8% | | PZ107 | Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust, North East | 84 | 84 | 84 | 0 | 0.0% | 11.9% | 78.5 | 74.5 | 21.5% | | PZ108 | Birmingham Children's Hospital, Birmingham Children's Hospital NHS Foundation Trust, West Midlands | 343 | 339 | 286 | 53 | 15.6% | 22.4% | 70.2 | 67.2 | 65.4% | | PZ109 | Southampton General Hospital, Southampton University Hospitals NHS Trust, South Central | 249 | 247 | 215 | 32 | 13.0% | 19.1% | 69.7 | 67.2 | 19.0% | | PZ110 | Ormskirk District General Hospital, Southport and Ormskirk NHS Trust, North West | 102 | 102 | 92 | 10 | 9.8% | 28.3% | 69.7 | 65.0 | 51.2% | | PZ111 | Hereford County Hospital, Wye Valley NHS Trust, West Midlands | 67 | 66 | 60 | 6 | 9.1% | 21.7% | 68.9 | 67.2 | 27.2% | | PZ112 | Scarborough General Hospital, Scarborough and North East Yorkshire Healthcare NHS Trust, Yorkshire and the Humber | 92 | 91 | 83 | 8 | 8.8% | 14.5% | 67.7 | 65.6 | 38.3% | | PZ113 | University Hospital of Wales, Cardiff and Vale University Health Board, | 226 | 225 | 192 | 33 | 14.7% | 10.9% | 77.8 | 76.2 | 37.5% | | PDU code | PDU Name | Total no. of patients submitted to NPDA | Total no. of patients eligible for HbA1c analysis\* | Patients used for HbA1c outcome analysis | Patients excluded from HbA1c outcome analysis | % excluded from HbA1c outcome analysis | % with HbA1c\<58 mmol/mol | Mean HbA1c (mmol/mol) | Median HbA1c (mmol/mol) | % of incomplete records of care processes except Hba1c | |----------|--------------------------------------------------------------------------|----------------------------------------|---------------------------------------------------|----------------------------------------|---------------------------------------------|----------------------------------------|-----------------------------------|------------------------|------------------------|-----------------------------------------------| | PZ114 | Wales York District Hospital, York Teaching Hospital NHS Foundation Trust, Yorkshire and the Humber | 158 | 157 | 153 | 4 | 2.5% | 16.3% | 69.7 | 66.0 | 51.0% | | PZ118 | University Hospital Lewisham, Lewisham and Greenwich NHS Trust, London and South East | 115 | 111 | 83 | 28 | 25.2% | 20.5% | 74.2 | 68.0 | 17.5% | | PZ119 | Darent Valley Hospital, Dartford and Gravesham NHS Trust, London and South East | 85 | 84 | 69 | 15 | 17.9% | 15.9% | 67.0 | 66.7 | 25.0% | | PZ120 | North Tyneside General Hospital, North Shields, Northumbria Healthcare NHS Foundation Trust, North East | 116 | 114 | 101 | 13 | 11.4% | 10.9% | 73.3 | 71.0 | 50.9% | | PZ121 | George Eliot Hospital, George Elliot Hospital NHS Trust, West Midlands | 76 | 76 | 53 | 23 | 30.3% | 20.8% | 74.4 | 74.0 | 41.9% | | PZ122 | University Hospital Coventry, University Hospitals Coventry and Warwickshire NHS Trust, West Midlands | 185 | 182 | 157 | 25 | 13.7% | 10.2% | 78.4 | 75.0 | 52.6% | | PZ125 | Maidstone Hospital, Maidstone and Tunbridge Wells Area and NHS Trust, London and South East | 95 | 95 | 87 | 8 | 8.4% | 20.7% | 68.2 | 67.0 | 77.0% | | PZ126 | Medway Maritime Hospital, Medway NHS Foundation Trust, London and South East | 247 | 246 | 213 | 33 | 13.4% | 15.5% | 74.5 | 71.6 | 47.6% | | PZ127 | James Paget Hospital, James Paget University Hospitals NHS Foundation Trust, East of England | 121 | 120 | 103 | 17 | 14.2% | 8.7% | 75.7 | 71.6 | 39.5% | | PZ128 | Pilgrim Hospital, United Lincolnshire | 94 | 91 | 73 | 18 | 19.8% | 19.2% | 68.7 | 66.0 | 48.9% | | PDU code | PDU Name | Total no. of patients submitted to NPDA | Total no. of patients eligible for HbA1c analysis\* | Patients used for HbA1c outcome analysis \*\* | Patients excluded from HbA1c outcome analysis | % excluded from HbA1c outcome analysis | % with HbA1c\<58 mmol/mol | Mean HbA1c (mmol/mol) | Median HbA1c (mmol/mol) | % of incomplete records of care processes except Hba1c | |----------|--------------------------------------------------------------------------|----------------------------------------|---------------------------------------------------|---------------------------------------------|---------------------------------------------|--------------------------------------|----------------------------|------------------------|------------------------|---------------------------------------------| | PZ129 | Hospitals NHS Trust, East Midlands | 75 | 75 | 65 | 10 | 13.3% | 18.5% | 70.8 | 69.5 | 57.0% | | PZ130 | Chelsea and Westminster Hospital, Chelsea and Westminster Hospital NHS Trust, London and South East | 171 | 168 | 152 | 16 | 9.5% | 13.8% | 73.3 | 71.0 | 19.8% | | PZ131 | Peterborough General, Peterborough and Stamford Hospitals NHS Trust, East of England | 172 | 171 | 153 | 18 | 10.5% | 9.8% | 75.9 | 73.0 | 26.7% | | PZ132 | Ysbyty Gwynedd Hospital, Besti Cadwaladr University Health Board, Wales | 115 | 113 | 86 | 27 | 23.9% | 10.5% | 74.9 | 70.0 | 47.3% | | PZ133 | James Cook University Hospital, South Tees Hospitals NHS Trust, North East | 140 | 139 | 122 | 17 | 12.2% | 21.3% | 68.9 | 64.4 | 35.0% | | PZ134 | Trafford General Hospital, Trafford Healthcare NHS Trust, North West | 69 | 69 | 64 | 5 | 7.2% | 12.5% | 76.0 | 72.0 | 23.8% | | PZ135 | Royal Alexandra Hospital, Brighton and Sussex University Hospitals NHS Trust, London and South East | 164 | 162 | 144 | 18 | 11.1% | 17.4% | 71.5 | 69.0 | 30.7% | | PZ136 | Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, North West | 241 | 231 | 188 | 43 | 18.6% | 22.3% | 72.0 | 69.8 | 54.4% | | PZ137 | Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, South West | 186 | 183 | 165 | 18 | 9.8% | 20.6% | 72.1 | 68.5 | 54.6% | | PZ138 | Warwick Hospital | 92 | 91 | 79 | 12 | 13.2% | 10.1% | 76.2 | 75.0 | 29.0% | | PZ139 | Bristol Royal Hospital for Children, | 471 | 466 | 403 | 63 | 13.5% | 24.8% | 69.0 | 66.0 | 30.4% | | PDU Code | PDU Name | Total no. of patients submitted to NPDA | Total no. of patients eligible for HbA1c analysis\* | Patients used for HbA1c outcome analysis \*\* | Patients excluded from HbA1c outcome analysis | % excluded from HbA1c outcome analysis | % with HbA1c < 58 mmol/mol | Mean HbA1c (mmol/mol) | Median HbA1c (mmol/mol) | % of incomplete records of care processes except HbA1c | |----------|----------|----------------------------------------|--------------------------------------------------|---------------------------------------------|---------------------------------------------|--------------------------------------|---------------------------------|------------------------|------------------------|---------------------------------------------| | PZ140 | University Hospitals Bristol NHS Foundation Trust, South West | 66 | 63 | 53 | 10 | 15.9% | 5.7% | 79.4 | 76.0 | 3.95% | | PZ141 | Tameside General Hospital, Tameside NHS Foundation Trust, North West | 63 | 61 | 54 | 7 | 11.5% | 5.6% | 75.7 | 72.1 | 16.7% | | PZ143 | South Tyneside District Hospital, South Tyneside NHS Foundation Trust, North East | 138 | 128 | 102 | 26 | 20.3% | 13.7% | 77.8 | 74.5 | 66.9% | | PZ144 | King George Hospital, Haringey and Enfield University Hospitals NHS Trust, London and South East | 146 | 144 | 125 | 19 | 13.2% | 8.8% | 77.9 | 72.7 | 52.4% | | PZ145 | Good Hope Hospital, Heart of England NHS Foundation Trust, West Midlands | 113 | 112 | 95 | 17 | 15.2% | 19.0% | 69.0 | 67.2 | 59.1% | | PZ146 | Milton Keynes Hospital, Milton Keynes Hospital NHS Foundation Trust, South Central | 120 | 119 | 100 | 19 | 16.0% | 13.0% | 74.5 | 71.6 | 66.7% | | PZ149 | Southend General Hospital, Southend University Hospital NHS Foundation Trust, East of England | 128 | 125 | 110 | 15 | 12.0% | 10.0% | 73.8 | 70.5 | 19.1% | | PZ150 | Barnsley District General Hospital, Barnsley Hospital NHS Foundation Trust, Yorkshire and the Humber | 104 | 104 | 91 | 13 | 12.5% | 15.0% | 74.6 | 73.8 | 63.1% | | PZ151 | Cumberland Infirmary, Cumbria Partnership NHS Foundation Trust, North East | 114 | 113 | 94 | 19 | 16.8% | 10.6% | 78.8 | 79.2 | 51.2% | | PZ152 | Queen Elizabeth Hospital Lewisham and Greenwich NHS Trust, London and South East | 108 | 105 | 93 | 12 | 11.4% | 5.4% | 77.9 | 75.0 | 28.5% | | PDU code | PDU Name | Total no. of patients submitted to NPDA | Total no. of patients eligible for HbA1c analysis\* | Patients used for HbA1c outcome analysis | Patients excluded from HbA1c outcome analysis | % excluded from HbA1c outcome analysis | % with HbA1c\<58 mmol/mol | Mean HbA1c (mmol/mol) | Median HbA1c (mmol/mol) | % of incomplete records of care processes except Hba1c | |----------|--------------------------------------------------------------------------|----------------------------------------|---------------------------------------------------|------------------------------------------|---------------------------------------------|--------------------------------------|----------------------------|----------------------|------------------------|-----------------------------------------------| | PZ153 | Healthcare NHS Foundation Trust, South West | 170 | 170 | 141 | 29 | 17.1% | 16.3% | 71.7 | 68.9 | 20.0% | | PZ156 | Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, North West | 152 | 147 | 128 | 19 | 12.9% | 7.8% | 81.4 | 80.3 | 44.8% | | PZ157 | Queen Elizabeth, Kings Lynn, Queen Elizabeth Hospitals NHS Trust, East of England | 54 | 50 | 44 | 6 | 12.0% | 6.8% | 68.7 | 66.1 | 23.2% | | PZ158 | Royal Free and University College Hospital, Royal Free Hampstead NHS Trust, London and South East | 66 | 62 | 56 | 6 | 9.7% | 12.5% | 72.6 | 72.0 | 25.0% | | PZ159 | Epsom General Hospital, Epsom and St Helier University Hospitals NHS Trust, London and South East | 142 | 141 | 127 | 14 | 9.9% | 19.7% | 69.4 | 66.1 | 39.0% | | PZ162 | Basingstoke and North Hampshire Hospital, Basingstoke and North Hampshire NHS Foundation Trust, South Central | 135 | 135 | 99 | 36 | 26.7% | 15.2% | 73.6 | 71.5 | 70.7% | | PZ163 | Bishop Auckland General Hospital, County Durham and Darlington NHS Foundation Trust, North East | 147 | 143 | 128 | 15 | 10.5% | 14.8% | 71.1 | 69.5 | 44.3% | | PZ164 | North Tees General Hospital, North Tees and Hartlepool NHS Trust, North East | 110 | 109 | 101 | 8 | 7.3% | 15.8% | 73.1 | 68.0 | 28.2% | | PZ167 | Rotherham General Hospital, The Rotherham NHS Foundation Trust, Yorkshire and the Humber | 149 | 147 | 124 | 23 | 15.6% | 5.7% | 72.1 | 69.0 | 32.6% | | PDU Code | PDU Name | Trust, Region | Total no. of patients submitted to NPDA | Total no. of patients eligible for HbA1c analysis\* | Patients used for HbA1c outcome analysis \*\* | Patients excluded from HbA1c outcome analysis | % with HbA1c\<58 mmol/mol | Mean HbA1c (mmol/mol) | Median HbA1c (mmol/mol) | % of incomplete records of care processes except HbA1c | |----------|----------|---------------|----------------------------------------|-----------------------------------------------|---------------------------------------------|---------------------------------------------|--------------------------|------------------------|------------------------|---------------------------------------------| | PZ168 | Grantham and District Hospital, United Lincolnshire Hospitals NHS Trust, East Midlands | 39 | 37 | 2 | 5.4% | 20.0% | 66.0 | 66.5 | 66.0 | 53.3% | | PZ169 | Salisbury District Hospital, Salisbury NHS Foundation Trust, South Central England | 108 | 106 | 16 | 15.1% | 11.0% | 15.8% | 15.8% | 15.8% | 43.3% | | PZ170 | Arrowe Park Hospital, Wirral University Teaching Hospital NHS Foundation Trust, North West England | 121 | 119 | 99 | 16.8% | 12.8% | 9.4% | 9.4% | 9.4% | 69.1% | | PZ171 | Broomfield Hospital, Mid-Essex Hospital Services NHS Trust, East of England | 165 | 164 | 146 | 11.0% | 12.8% | 9.4% | 9.4% | 9.4% | 65.3% | | PZ172 | Watford General Hospital, West Herts Hospitals NHS Trust, East of England | 198 | 195 | 170 | 12.8% | 12.8% | 9.4% | 9.4% | 9.4% | 67.2% | | PZ173 | Yeovil District Hospital, Yeovil District Hospital NHS Foundation Trust, South West England | 75 | 75 | 75 | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 67.2% | | PZ174 | Kettering General Hospital, Kettering General Hospital NHS Foundation Trust, East Midlands | 117 | 115 | 100 | 13.0% | 13.0% | 13.0% | 13.0% | 13.0% | 64.7% | | PZ175 | Queen Mary's Hospital, South London Healthcare NHS Trust, South East England | 129 | 129 | 129 | 10.9% | 10.9% | 10.9% | 10.9% | 10.9% | 64.7% | | PZ176 | Royal Bolton Hospital, Bolton Hospital NHS Foundation Trust, North West England | 155 | 155 | 155 | 10.3% | 10.3% | 10.3% | 10.3% | 10.3% | 67.3% | | PZ177 | St Peter's Hospital, Ashford and St Peter's Hospitals NHS Trust, London and South East England | 108 | 107 | 87 | 18.7% | 18.7% | 18.7% | 18.7% | 18.7% | 69.7% | | PZ178 | Manor Hospital, Walsall Healthcare NHS Trust, West Midlands | 113 | 113 | 113 | 5.3% | 5.3% | 5.3% | 5.3% | 5.3% | 77.9% | | PDU code | PDU Name | Total no. of patients submitted to NPDA | Total no. of patients eligible for HbA1c analysis\* | Patients used for HbA1c outcome analysis | Patients excluded from HbA1c outcome analysis | % excluded from HbA1c outcome analysis | % with HbA1c\<58 mmol/mol | Mean HbA1c (mmol/mol) | Median HbA1c (mmol/mol) | % of incomplete records of care processes except HbA1c | |----------|--------------------------------------------------------------------------|----------------------------------------|---------------------------------------------------|------------------------------------------|---------------------------------------------|----------------------------------------|----------------------------|------------------------|------------------------|---------------------------------------------| | PZ179 | Countess of Chester Hospital NHS Foundation Trust, Countess Of Chester Hospital NHS Foundation Trust, North West | 114 | 114 | 104 | 10 | 8.8% | 26.9% | 71.5 | 66.8 | 29.1% | | PZ180 | King’s Mill Hospital, Sherwood Forest Hospitals NHS Foundation Trust, East Midlands | 146 | 145 | 128 | 17 | 11.7% | 17.2% | 67.9 | 66.1 | 21.0% | | PZ181 | Ipswich Hospital, The Ipswich Hospital NHS Trust, East of England | 222 | 219 | 189 | 30 | 13.7% | 15.9% | 74.8 | 73.8 | 29.3% | | PZ182 | West Middlesex University Hospital, West Middlesex University Hospital NHS Trust, London and South East | 105 | 104 | 92 | 12 | 11.5% | 12.0% | 81.2 | 77.8 | 44.1% | | PZ183 | Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, North West | 196 | 193 | 175 | 18 | 9.3% | 13.1% | 75.3 | 73.0 | 59.4% | | PZ184 | Eastbourne District General Hospital, East Sussex NHS Trust, London and South East | 57 | 57 | 41 | 16 | 28.1% | 24.4% | 68.7 | 67.0 | 10.8% | | PZ185 | Bronglais General Hospital, Hywel Dda Local Health Board, Wales | 44 | 43 | 42 | 1 | 2.3% | 23.8% | 68.9 | 68.3 | 10.8% | | PZ186 | Huddersfield Royal Infirmary, Calderdale and Huddersfield NHS Foundation Trust, Yorkshire and the Humber | 201 | 199 | 173 | 26 | 13.1% | 16.8% | 73.3 | 70.0 | 19.6% | | PZ187 | Wrexham Maelor Hospital, Besti Cadwaladr University Health Board, Wales | 93 | 93 | 77 | 16 | 17.2% | 19.5% | 67.6 | 66.1 | 12.7% | | PZ188 | Royal Gwent Hospital, Aneurin Bevan Health Board, Wales | 199 | 199 | 165 | 34 | 17.1% | 9.1% | 77.4 | 73.0 | 47.4% | | PZ189 | Royal Glamorgan Hospital, Cwm Taf | 81 | 80 | 69 | 11 | 13.8% | 20.3% | 70.7 | 69.0 | 9.5% | | PDU Code | PDU Name | Total no. of patients submitted to NPDA | Total no. of patients eligible for HbA1c analysis\* | Patients used for HbA1c outcome analysis \*\* | Patients excluded from HbA1c outcome analysis | % excluded from HbA1c outcome analysis | % with HbA1c\<58 mmol/mol | Mean HbA1c (mmol/mol) | Median HbA1c (mmol/mol) | % of incomplete records of care processes except HbA1c | |----------|----------|----------------------------------------|--------------------------------------------------|---------------------------------------------|---------------------------------------------|--------------------------------------|----------------------------|------------------------|------------------------|---------------------------------------------| | PZ190 | Health Board, Wales | 52 | 52 | 47 | 5 | 9.6% | 4.3% | 76.0 | 72.0 | 27.1% | | PZ191 | Withybush General Hospital, Hywel Dda Health Board, Wales | 124 | 120 | 105 | 15 | 12.5% | 7.6% | 83.3 | 80.3 | 81.1% | | PZ193 | Ealing Hospital, Ealing Hospital NHS Trust, London and South East | 45 | 45 | 36 | 9 | 20.0% | 11.1% | 66.6 | 69.0 | 48.0% | | PZ195 | Neath Port Talbot Hospital, Abertawe Bro Morgannwg University Health Board, Wales | 79 | 72 | 62 | 10 | 13.9% | 9.7% | 87.7 | 87.0 | 53.8% | | PZ196 | Central Middlesex Hospital, North West London Hospitals NHS Trust, London and South East | 32 | 29 | 18 | 11 | 62.1% | 72.7% | 53.9 | 47.5 | 50.8% | | PZ199 | Great Ormond Street Hospital, London, Great Ormond Street University Hospital, London and South East | 121 | 114 | 104 | 10 | 8.8% | 10.6% | 74.3 | 71.3 | 22.3% | | PZ200 | North Middlesex University Hospital, North Middlesex University Hospital NHS Trust, London and South East | 90 | 84 | 74 | 10 | 11.9% | 5.4% | 81.5 | 76.5 | 30.5% | | PZ202 | The Princess Alexandra Hospital NHS Trust, East of England | 93 | 91 | 74 | 17 | 18.7% | 5.4% | 74.7 | 71.0 | 4.2% | | PZ203 | St Mary's Hospital, Imperial College Healthcare NHS Trust, London and South East | 380 | 342 | 304 | 38 | 11.1% | 33.2% | 64.1 | 61.8 | 89.9% | | PZ213 | East Surrey Hospital, Surrey and Sussex NHS Trust, London and South East | 166 | 162 | 133 | 29 | 17.9% | 11.3% | 71.6 | 68.9 | 34.8% | | PDU code | PDU Name | Total no. of patients submitted to NPDA | Total no. of patients eligible for HbA1c analysis\* | Patients used for HbA1c outcome analysis | Patients excluded from HbA1c outcome analysis | % excluded from HbA1c outcome analysis | % with HbA1c\<58 mmol/mol | Mean HbA1c (mmol/mol) | Median HbA1c (mmol/mol) | % of incomplete records of care processes except HbA1c | |----------|--------------------------------------------------------------------------|----------------------------------------|---------------------------------------------------|------------------------------------------|---------------------------------------------|----------------------------------------|----------------------------|------------------------|------------------------|---------------------------------------------| | PZ215 | East King's College Hospital, King's College Hospital NHS Trust, London and South East | 135 | 132 | 123 | 9 | 6.8% | 9.8% | 80.5 | 77.1 | 49.2% | | PZ216 | Tunbridge Wells Hospital, Maidstone and Tunbridge Wells Area and NHS Trust, London and South East | 97 | 97 | 84 | 13 | 13.4% | 21.4% | 67.9 | 65.3 | 73.1% | | PZ218 | Frimley Park Hospital, Frimley Park Hospital NHS Trust, London and South East | 161 | 155 | 135 | 20 | 12.9% | 17.0% | 71.0 | 67.0 | 33.5% | | PZ219 | Sheffield Children's Hospital, Sheffield Children's NHS Foundation Trust, Yorkshire and the Humber | 228 | 227 | 197 | 30 | 13.2% | 26.4% | 68.2 | 66.1 | 34.2% | | PZ220 | Bedford Hospital, Bedford Hospital NHS Trust, East of England | 124 | 122 | 104 | 18 | 14.8% | 7.7% | 79.1 | 76.0 | 66.2% | | PZ221 | The Great Western Hospital, Great Western Hospitals NHS Foundation Trust, South West | 143 | 142 | 123 | 19 | 13.4% | 14.6% | 77.2 | 73.5 | 62.2% | | PZ222 | New Cross Hospital, The Royal Wolverhampton Hospitals NHS Trust, West Midlands | 179 | 179 | 154 | 25 | 14.0% | 13.6% | 73.6 | 70.0 | 12.7% | | PZ223 | Sandwell General Hospital, Sandwell and West Birmingham Hospitals NHS Trust, West Midlands | 119 | 118 | 96 | 22 | 18.6% | 31.3% | 67.3 | 64.8 | 12.1% | | PZ225 | Worcester Hospital, Worcestershire Acute Hospitals NHS Trust, West Midlands | 124 | 123 | 112 | 11 | 8.9% | 15.2% | 75.5 | 73.0 | 23.0% | | PZ226 | Dewsbury and District Hospital, The Mid Yorkshire Hospitals NHS Trust, Yorkshire and the Humber | 82 | 81 | 69 | 12 | 14.8% | 10.1% | 77.7 | 75.0 | 57.5% | | PDU code | PDU Name | Total no. of patients submitted to NPDA | Total no. of patients eligible for HbA1c analysis\* | Patients used for HbA1c outcome analysis \*\* | Patients excluded from HbA1c outcome analysis | % excluded from HbA1c\<58 mmol/mol | % with HbA1c\<58 mmol/mol | Mean HbA1c (mmol/mol) | Median HbA1c (mmol/mol) | % of incomplete records of care processes except Hba1c | |----------|--------------------------------------------------------------------------|----------------------------------------|---------------------------------------------------|---------------------------------------------|---------------------------------------------|---------------------------------|------------------------|----------------------|------------------------|--------------------------| | PZ228 | Prince Charles Hospital, Cwm Taf Health Board, Wales | 69 | 69 | 65 | 4 | 5.8% | 35.4% | 62.1 | 59.0 | 3.9% | | PZ230 | Conquest Hospital, East Sussex NHS Trust, London and South East | 49 | 46 | 40 | 6 | 13.0% | 15.0% | 73.2 | 70.8 | 34.2% | | PZ231 | Salford Royal Hospital, Salford Royal NHS Foundation Trust, North West | 140 | 140 | 126 | 14 | 10.0% | 17.5% | 71.5 | 67.5 | 23.3% | | PZ232 | Queens Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust, North West | 167 | 163 | 143 | 20 | 12.3% | 11.9% | 76.1 | 73.0 | 47.6% | | PZ234 | North Manchester General Hospital, The Pennine Acute Hospitals NHS Trust, North West | 277 | 275 | 152 | 123 | 44.7% | 13.8% | 72.3 | 69.4 | 64.9% | | PZ238 | Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, South West | 221 | 216 | 189 | 27 | 12.5% | 13.2% | 70.3 | 69.0 | 36.2% | | PZ240 | Russell's Hall Hospital, The Dudley Group of Hospitals NHS Foundation Trust, West Midlands | 156 | 155 | 103 | 52 | 33.5% | 7.8% | 74.1 | 72.7 | 79.2% | | PZ242 | Cheltenham and Gloucester Hospital, Gloucestershire Hospitals NHS Trust, South West | 296 | 296 | 239 | 57 | 19.3% | 15.5% | 70.3 | 67.0 | 49.0% |

\*Eligible patients were those greater than 3 month post diagnosis.

\*\*For HbA1c to be included in the analysis the patient needed a valid date of diagnosis, a valid submitted value and a date of submission which was within the Audit year. Where more than one HbA1c was submitted for a patient the median value was used for the Audit year. The following Paediatric Diabetes Units submitted their data through other Units:

| Code | Description | |-------|-----------------------------------------------------------------------------| | PZ003 | PZ003 Pinderfields General Hospital, Wakefield (submitted via PZ090) The Mid Yorkshire Hospitals NHS Trust | | PZ013 | PZ013 Furness General Hospital (submitted via PZ167) University Hospitals of Morecambe Bay NHS Foundation Trust | | PZ029 | PZ029 Fairfield General Hospital, Bury, PZ206 Rochdale Infirmary and PZ044 Royal Oldham Hospital (Submitted via PZ234) The Pennine Acute Hospitals NHS Trust Fairfield General Hospital, Bury | | PZ043 | PZ043 St Mary's Hospital for Women and Children Manchester (submitted via PZ136) Central Manchester University Hospitals NHS Foundation Trust NW | | PZ044 | PZ044 Royal Oldham Hospital (submitted via PZ206) The Pennine Acute Hospitals NHS Trust Submitted via PZ234 | | PZ046 | PZ046 Horton Hospital (submitted via PZ007) Oxford Radcliffe Hospitals NHS Trust SC | | PZ095 | PZ095 Royal Shrewsbury Hospital (submitted via PZ094) The Shrewsbury and Telford Hospital NHS Trust WM | | PZ116 | PZ116 Nottingham University Hospital (submitted via PZ042) Nottingham University Hospitals NHS Trust EM | | PZ161 | PZ161 Darlington Memorial Hospital and PZ160 Bishop Auckland General Hospital (submitted via PZ162) County Durham and Darlington NHS Foundation Trust | | PZ208 | PZ208 Westmoreland General Hospital (submitted via PZ167) University Hospitals of Morecambe Bay NHS Foundation | | PZ210 | PZ210 University Hospital of Hartlepool (submitted via PZ163) North Tees and Hartlepool NHS Trust NE | 10. Appendix B: unadjusted and adjusted Paediatric Diabetes Unit co-ordinates for funnel plots

| PDU code | PDU size | Unadjusted | Adjusted | |----------|----------|------------|----------| | | | Mean HbA1c | Proportion (%) with HbA1c >80 mmol/mol | Mean HbA1c | Proportion (%) with HbA1c >80 mmol/mol | | PZ001 | 108 | 70.3 | 19 (18%) | 71.1 | 22 (21%) | | PZ002 | 56 | 73.9 | 17 (30%) | 73.7 | 18 (31%) | | PZ004 | 172 | 72.8 | 41 (24%) | 74.3 | 49 (29%) | | PZ005 | 223 | 70.0 | 45 (20%) | 69.4 | 44 (20%) | | PZ006 | 123 | 66.2 | 21 (17%) | 65.5 | 20 (16%) | | PZ007 | 299 | 64.0 | 26 (9%) | 64.9 | 31 (10%) | | PZ009 | 84 | 69.9 | 18 (21%) | 71.9 | 23 (27%) | | PZ010 | 106 | 75.5 | 33 (31%) | - | - | | PZ011 | 105 | 80.3 | 47 (45%) | 80.7 | 51 (49%) | | PZ012 | 75 | 76.2 | 22 (29%) | 75.2 | 21 (28%) | | PZ014 | 47 | 76.5 | 13 (28%) | 76.2 | 13 (28%) | | PZ015 | 55 | 70.7 | 9 (16%) | 70.2 | 9 (17%) | | PZ016 | 58 | 71.2 | 12 (21%) | 70.1 | 11 (19%) | | PZ017 | 83 | 70.6 | 18 (22%) | 70.0 | 18 (22%) | | PZ018 | 118 | 76.4 | 42 (36%) | 76.1 | 43 (36%) | | PZ019 | 201 | 75.0 | 71 (35%) | 73.8 | 65 (32%) | | PZ020 | 93 | 78.6 | 36 (39%) | 78.0 | 38 (41%) | | PZ021 | 139 | 71.5 | 33 (24%) | 71.5 | 34 (24%) | | PZ022 | 34 | 76.5 | 9 (26%) | 77.0 | 10 (29%) | | PZ024 | 281 | 74.9 | 88 (31%) | 74.4 | 90 (32%) | | PZ026 | 230 | 75.4 | 71 (31%) | 74.0 | 64 (28%) | | PZ027 | 55 | 69.9 | 10 (18%) | 71.4 | 12 (22%) | | PZ028 | 77 | 73.9 | 19 (25%) | 74.3 | 21 (27%) | | PZ030 | 98 | 65.5 | 14 (14%) | 66.2 | 16 (16%) | | PZ031 | 81 | 74.0 | 24 (30%) | 75.1 | 30 (37%) | | PZ032 | 283 | 71.8 | 70 (25%) | 71.0 | 68 (24%) | | PZ033 | 105 | 72.3 | 27 (26%) | 71.8 | 26 (25%) | | PZ034 | 124 | 73.3 | 34 (27%) | 73.9 | 38 (30%) | | PZ035 | 209 | 67.2 | 26 (12%) | 68.0 | 30 (14%) | | PZ036 | 98 | 71.0 | 19 (19%) | 69.5 | 17 (18%) | | PZ038 | 102 | 75.5 | 31 (30%) | 77.2 | 37 (36%) | | PZ040 | 207 | 80.2 | 91 (44%) | 79.2 | 87 (42%) | | PZ041 | 239 | 74.0 | 64 (27%) | 75.6 | 78 (33%) | | PZ042 | 264 | 65.6 | 34 (13%) | 65.4 | 35 (13%) | | PZ045 | 56 | 81.2 | 26 (46%) | 76.4 | 19 (34%) | | PDU code | PDU size | Unadjusted | Adjusted | |----------|----------|------------|----------| | | | Mean HbA1c | Proportion (%) with HbA1c >80 mmol/mol | Mean HbA1c | Proportion (%) with HbA1c >80 mmol/mol | | PZ047 | 66 | 70.2 | 12 (18%) | 69.8 | 12 (18%) | | PZ048 | 107 | 72.9 | 28 (26%) | 73.5 | 32 (30%) | | PZ049 | 140 | 67.4 | 21 (15%) | 67.3 | 22 (16%) | | PZ050 | 101 | 78.0 | 34 (34%) | 77.9 | 36 (35%) | | PZ052 | 66 | 76.2 | 19 (29%) | 76.6 | 22 (33%) | | PZ053 | 79 | 74.3 | 22 (28%) | 73.5 | 21 (27%) | | PZ054 | 161 | 70.1 | 36 (22%) | 71.9 | 45 (28%) | | PZ055 | 325 | 73.6 | 100 (31%) | 73.9 | 103 (32%) | | PZ056 | 56 | 69.1 | 8 (14%) | 69.5 | 10 (17%) | | PZ057 | 132 | 65.7 | 16 (12%) | 67.4 | 19 (14%) | | PZ058 | 90 | 79.0 | 42 (47%) | 74.1 | 28 (31%) | | PZ059 | 161 | 70.0 | 35 (22%) | 67.6 | 29 (18%) | | PZ060 | 159 | 75.8 | 58 (36%) | 74.6 | 54 (34%) | | PZ062 | 83 | 75.4 | 24 (29%) | 73.3 | 21 (25%) | | PZ064 | 112 | 71.5 | 23 (21%) | 71.5 | 26 (23%) | | PZ065 | 104 | 76.3 | 33 (32%) | 75.7 | 33 (32%) | | PZ067 | 17 | 71.6 | 6 (35%) | 68.2 | 5 (31%) | | PZ068 | 175 | 75.6 | 56 (32%) | 77.0 | 69 (39%) | | PZ069 | 122 | 68.1 | 20 (16%) | 69.2 | 23 (19%) | | PZ072 | 108 | 67.1 | 12 (11%) | 68.8 | 16 (15%) | | PZ073 | 83 | 74.6 | 20 (24%) | 75.0 | 23 (27%) | | PZ074 | 211 | 72.4 | 50 (24%) | 70.8 | 46 (22%) | | PZ075 | 45 | 75.7 | 13 (29%) | 74.9 | 13 (28%) | | PZ076 | 167 | 81.6 | 84 (50%) | 80.5 | 83 (49%) | | PZ078 | 189 | 75.0 | 60 (32%) | 74.5 | 60 (32%) | | PZ080 | 149 | 68.5 | 25 (17%) | 66.9 | 22 (15%) | | PZ082 | 83 | 81.8 | 37 (45%) | 78.8 | 31 (37%) | | PZ084 | 59 | 75.7 | 16 (27%) | 75.4 | 16 (28%) | | PZ085 | 88 | 69.2 | 17 (19%) | 76.9 | 0 (0%) | | PZ086 | 83 | 73.5 | 24 (29%) | 74.0 | 27 (33%) | | PZ088 | 42 | 61.7 | 3 (7%) | 64.6 | 5 (11%) | | PZ089 | 21 | 83.2 | 11 (52%) | 82.7 | 10 (47%) | | PZ090 | 172 | 71.2 | 43 (25%) | 70.2 | 43 (25%) | | PZ091 | 222 | 71.5 | 51 (23%) | 70.6 | 49 (22%) | | PZ092 | 73 | 77.3 | 27 (37%) | 77.3 | 28 (39%) | | PZ094 | 225 | 73.0 | 66 (29%) | 72.6 | 64 (28%) | | PZ096 | 153 | 66.4 | 21 (14%) | 66.2 | 22 (14%) | | PZ097 | 28 | 72.7 | 9 (32%) | 68.5 | 6 (21%) | | PZ099 | 216 | 72.3 | 48 (22%) | 73.3 | 55 (25%) | | PZ100 | 70 | 69.6 | 11 (16%) | 67.2 | 10 (14%) | | PZ101 | 295 | 67.1 | 49 (17%) | 66.9 | 50 (17%) | | PZ102 | 131 | 76.5 | 42 (32%) | 75.2 | 39 (29%) | | PDU code | PDU size | Unadjusted | Adjusted | |----------|----------|------------|----------| | | | Mean HbA1c | Proportion (%) with HbA1c >80 mmol/mol | Mean HbA1c | Proportion (%) with HbA1c >80 mmol/mol | | PZ104 | 107 | 74.8 | 38 (36%) | 74.8 | 39 (36%) | | PZ105 | 156 | 76.9 | 58 (37%) | 74.3 | 48 (31%) | | PZ106 | 94 | 70.4 | 15 (16%) | 70.2 | 16 (17%) | | PZ107 | 84 | 78.5 | 35 (42%) | 76.0 | 29 (35%) | | PZ108 | 286 | 70.2 | 67 (23%) | 67.7 | 55 (19%) | | PZ109 | 215 | 69.7 | 39 (18%) | 69.8 | 40 (19%) | | PZ110 | 92 | 69.7 | 21 (23%) | 69.9 | 23 (25%) | | PZ111 | 60 | 68.9 | 10 (17%) | 70.0 | 12 (20%) | | PZ112 | 83 | 67.7 | 12 (14%) | 66.9 | 12 (14%) | | PZ113 | 192 | 77.8 | 74 (39%) | 77.0 | 80 (42%) | | PZ114 | 153 | 69.7 | 28 (18%) | 70.4 | 31 (20%) | | PZ118 | 83 | 74.2 | 26 (31%) | 70.6 | 20 (24%) | | PZ119 | 69 | 67.0 | 5 (7%) | 69.5 | 7 (11%) | | PZ120 | 101 | 73.3 | 24 (24%) | 72.9 | 25 (25%) | | PZ121 | 53 | 74.4 | 17 (32%) | 74.1 | 19 (37%) | | PZ122 | 157 | 78.4 | 57 (36%) | 77.7 | 55 (35%) | | PZ125 | 87 | 68.2 | 13 (15%) | 69.6 | 15 (18%) | | PZ126 | 213 | 74.5 | 62 (29%) | 72.9 | 55 (26%) | | PZ127 | 103 | 75.7 | 34 (33%) | 74.2 | 31 (30%) | | PZ128 | 73 | 68.7 | 13 (18%) | 68.3 | 13 (18%) | | PZ129 | 65 | 70.8 | 13 (20%) | 72.9 | 17 (26%) | | PZ130 | 152 | 73.3 | 48 (32%) | 71.9 | 43 (28%) | | PZ131 | 153 | 75.9 | 43 (28%) | 76.3 | 46 (30%) | | PZ132 | 86 | 74.9 | 20 (23%) | 74.1 | 19 (23%) | | PZ133 | 122 | 68.9 | 24 (20%) | 69.2 | 26 (21%) | | PZ134 | 64 | 76.0 | 19 (30%) | 73.7 | 16 (25%) | | PZ135 | 144 | 71.5 | 31 (22%) | 71.3 | 31 (22%) | | PZ136 | 188 | 72.0 | 47 (25%) | 70.4 | 42 (23%) | | PZ137 | 165 | 72.1 | 43 (26%) | 71.8 | 43 (26%) | | PZ138 | 79 | 76.2 | 27 (34%) | 77.3 | 31 (39%) | | PZ139 | 403 | 69.0 | 83 (21%) | 68.9 | 86 (21%) | | PZ140 | 53 | 79.4 | 24 (45%) | 80.3 | 27 (52%) | | PZ141 | 54 | 75.7 | 14 (26%) | 75.3 | 14 (26%) | | PZ143 | 102 | 77.8 | 43 (42%) | 75.5 | 37 (36%) | | PZ144 | 125 | 77.9 | 47 (38%) | 77.4 | 48 (38%) | | PZ145 | 95 | 69.0 | 20 (21%) | 69.8 | 23 (25%) | | PZ146 | 100 | 74.5 | 27 (27%) | 73.8 | 26 (26%) | | PZ149 | 110 | 73.8 | 25 (23%) | 71.6 | 22 (20%) | | PZ150 | 91 | 74.6 | 35 (38%) | 75.0 | 41 (45%) | | PZ151 | 94 | 78.8 | 45 (48%) | 75.8 | 35 (38%) | | PZ152 | 93 | 77.9 | 32 (34%) | 77.1 | 32 (35%) | | PZ153 | 141 | 71.7 | 36 (26%) | 70.1 | 32 (23%) | | PDU code | PDU size | Unadjusted | Adjusted | |----------|----------|------------|----------| | | | Mean HbA1c | Proportion (%) with HbA1c >80 mmol/mol | Mean HbA1c | Proportion (%) with HbA1c >80 mmol/mol | | PZ156 | 128 | 81.4 | 65 (51%) | 78.4 | 53 (41%) | | PZ157 | 44 | 68.7 | 8 (18%) | 66.9 | 8 (17%) | | PZ158 | 56 | 72.6 | 8 (14%) | 74.8 | 11 (19%) | | PZ159 | 127 | 69.4 | 24 (19%) | 70.1 | 27 (21%) | | PZ162 | 99 | 73.6 | 28 (28%) | 72.2 | 28 (28%) | | PZ163 | 128 | 71.1 | 24 (19%) | 71.0 | 25 (19%) | | PZ164 | 101 | 73.1 | 29 (29%) | 71.0 | 25 (25%) | | PZ167 | 124 | 72.1 | 26 (21%) | 73.2 | 32 (26%) | | PZ168 | 35 | 66.5 | 3 (9%) | 67.8 | 3 (10%) | | PZ169 | 90 | 74.0 | 29 (32%) | 74.5 | 32 (36%) | | PZ170 | 99 | 78.7 | 34 (34%) | 78.9 | 38 (38%) | | PZ171 | 146 | 67.2 | 15 (10%) | 68.8 | 18 (13%) | | PZ172 | 170 | 73.0 | 41 (24%) | 74.6 | 50 (29%) | | PZ173 | 75 | 74.4 | 20 (27%) | 74.1 | 20 (27%) | | PZ174 | 100 | 72.6 | 25 (25%) | 74.4 | 31 (31%) | | PZ175 | 115 | 64.7 | 10 (9%) | 63.8 | 10 (8%) | | PZ176 | 139 | 69.9 | 24 (17%) | 72.2 | 32 (23%) | | PZ177 | 87 | 69.7 | 13 (15%) | 69.1 | 13 (15%) | | PZ178 | 19 | 77.9 | 6 (32%) | 74.9 | 15 (78%) | | PZ179 | 104 | 71.5 | 28 (27%) | 72.0 | 31 (30%) | | PZ180 | 128 | 67.9 | 16 (13%) | 66.8 | 15 (12%) | | PZ181 | 189 | 74.8 | 59 (31%) | 74.4 | 59 (31%) | | PZ182 | 92 | 81.2 | 38 (41%) | 79.6 | 32 (35%) | | PZ183 | 175 | 75.3 | 53 (30%) | 75.8 | 59 (33%) | | PZ184 | 41 | 68.7 | 9 (22%) | 69.6 | 11 (26%) | | PZ185 | 42 | 68.9 | 8 (19%) | 69.9 | 10 (23%) | | PZ186 | 173 | 73.3 | 45 (26%) | 72.4 | 44 (25%) | | PZ187 | 77 | 67.6 | 9 (12%) | 69.0 | 11 (15%) | | PZ188 | 165 | 77.4 | 55 (33%) | 77.6 | 59 (36%) | | PZ189 | 69 | 70.7 | 15 (22%) | 71.0 | 17 (24%) | | PZ190 | 47 | 76.0 | 13 (28%) | 75.3 | 13 (28%) | | PZ191 | 105 | 83.3 | 56 (53%) | 82.1 | 53 (50%) | | PZ193 | 36 | 68.6 | 3 (8%) | 68.0 | 3 (9%) | | PZ195 | 62 | 87.7 | 38 (61%) | 81.8 | 25 (41%) | | PZ196 | 11 | 53.9 | 1 (9%) | 51.9 | 1 (6%) | | PZ199 | 104 | 74.3 | 31 (30%) | 70.5 | 23 (22%) | | PZ200 | 74 | 81.5 | 28 (38%) | 80.4 | 27 (36%) | | PZ202 | 74 | 74.7 | 21 (28%) | 71.8 | 17 (23%) | | PZ203 | 304 | 64.1 | 38 (13%) | 64.3 | 42 (14%) | | PZ213 | 133 | 71.6 | 28 (21%) | 71.6 | 32 (24%) | | PZ215 | 123 | 80.5 | 57 (46%) | 75.9 | 40 (33%) | | PZ216 | 84 | 67.9 | 10 (12%) | 70.5 | 14 (16%) | | PDU code | PDU size | Unadjusted | Adjusted | |----------|----------|------------|----------| | | | Mean HbA1c | Proportion (%) with HbA1c >80 mmol/mol | Mean HbA1c | Proportion (%) with HbA1c >80 mmol/mol | | PZ218 | 135 | 71.0 | 33 (24%) | 73.5 | 43 (32%) | | PZ219 | 197 | 68.2 | 37 (19%) | 67.9 | 38 (19%) | | PZ220 | 104 | 79.1 | 42 (40%) | 78.6 | 42 (40%) | | PZ221 | 123 | 77.2 | 44 (36%) | 78.5 | 54 (44%) | | PZ222 | 154 | 73.6 | 47 (31%) | 71.6 | 41 (26%) | | PZ223 | 96 | 67.3 | 16 (17%) | 64.8 | 13 (13%) | | PZ225 | 112 | 75.5 | 38 (34%) | 75.2 | 38 (34%) | | PZ226 | 69 | 77.7 | 25 (36%) | 77.6 | 25 (36%) | | PZ228 | 65 | 62.1 | 5 (8%) | 61.3 | 5 (8%) | | PZ230 | 40 | 73.2 | 9 (23%) | 73.8 | 10 (26%) | | PZ231 | 126 | 71.5 | 29 (23%) | 66.2 | 18 (14%) | | PZ232 | 143 | 76.1 | 50 (35%) | 75.2 | 50 (35%) | | PZ234 | 152 | 72.3 | 41 (27%) | 70.9 | 38 (25%) | | PZ238 | 189 | 70.3 | 34 (18%) | 70.4 | 36 (19%) | | PZ240 | 103 | 74.1 | 26 (25%) | 74.1 | 29 (28%) | | PZ242 | 239 | 70.3 | 43 (18%) | 71.8 | 51 (21%) | The Royal College of Paediatrics and Child Health (RCPCH) is a registered charity in England and Wales (1057744) and in Scotland (SC038299).